ࡱ> Y[X] bjbj{{ 4R1\1\ L>>>>>RRR84Rt&hzz"%%%%%%%$'*&>"&>>;.&>>%%r$T%pSxCFs$%D&0t&$++%+>%&&t&+> : 4Application Form Iligan National Writers Workshop Instructions: Fill out and return this application form along with your manuscript and a copy of it in CD (inside a suitable container) in MS Word format. Please send by post or JRS, LBC, etc. all documents in one envelope postmarked not later than March 30, 2015. Emailed or faxed applications will not be accepted. Please keep copies of your manuscripts because these will not be returned. Unpublished works are preferred. Last name First NameMiddle Name / / Male / / FemalePermanent Mailing Address Office or School Address Number and StreetNumber and Street City/Province/Zip/Postal Code City/Province/Zip/Postal Code Telephone/Email AddressTelephone/Email Address Date of Birth (month/day/year) Place of Birth (city, province, country) Citizenship/Group or Tribal Affiliation ReligionSelect your category: genre: / / Fiction: Short Story / / Novel: Work in progress / / Poetry / / Drama / / Language: / / English / / Filipino / / Tagalog / / Sebuano / / Hiligaynon / / Waray / / Chabacano / / other_______________ Education (course, year graduated/currently enrolled, school): Post-graduate Graduate Undergraduate Certificate Title(s) of works submitted with application. (Optional) If submitted work has been published, or, if it has won an award, please provide information. Published works (list title and publication) Use another sheet if necessary Questions (Please answer on a separate sheet of paper if necessary): Why I write My writing plans What the INWW fellowship would contribute to my writing plans Recommenders: Please list two persons who can speak about you and your work. There is no need for them to send us any letters of recommendation; we contact them if necessary.1. 1. Name 2. Number and Street 3. City, Province, Zip Code 4. Telephone and Email Address 5. Relationship2. 1. Name 2. Number and Street 3. City, Province, Zip Code 4. Telephone and Email Address 5. Relationship Certification of Original Work: I, __________________________, of legal age, a Filipino citizen, residing in_______________ certify that the work I have submitted to the Iligan National Writers Workshop is original or it is not taken or copied from any other work by any writer living or dead. Signature Residence Certificate number: Witness: _______________________ Mail all documents to: Christine F. Godinez-Ortega Director, 22nd Iligan National Writers Workshop Office of Publication & Information Office of the Chancellor 山- Iligan Institute of Technology, Iligan City Tel. (063) 221 4056 If you have any questions or if you have any changes, amendments to your application, please call Vera Mae F. 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