APPLICATION FORM

1 x 1 photo

Instructions: Fill out and return this application form along with the required manuscripts. Please
print all documents. Upon submission, place them in a short brown envelope.
PERSONAL DATA
Name
Age
Date
of
Birth
Perman
ent
Home
Address
Present
Home
Address
Contac
t
Details

Last name
Gende
r

First name
Religious
view

Middle name

Nickname

Place of
Birth

(Month/Day/Year)

Number/Street

City/Town

Province

Zip Code

Number/Street

City/Town

Province

Zip Code

Landline
Number(s)

Mobile Number(s)

Email Address(es)

ACADEMIC INFORMATION
Undergraduate

Graduate/Postgra
duate (e.g.
masters)

Name of Institution

Inclusive Years

Degree(s)
Pursued/Obtained

Name of Institution

Inclusive Years

Degree(s)
Pursued/Obtained

LANGUAGES YOU CAN WRITE

Local
Foreign Languages
Languages/Dialects

LITERARY GENRES
Poetry
Fiction
Non-Fiction Narrative/Literary
Essay
Drama/Play

MEMBERSHIP CATEGORY (Please check the box of the membership category you are applying
for.)
Category For writers1 with publication history and who have received fellowships from writers
workshops.
A
Category For writers2 whose works have already been published in literary anthologies, peerreviewed journals, etc.
B
Category For beginning writers.3
C
Category General Membership
D
SKILLS (Other than writing, please name the other skills you have, e.g. Adobe Photoshop, etc.)

PUBLICATION HISTORY (Fill out if applying for Categories A & B)

Title of Work
Genre
Name of Publication
Four Poems
Poetry
Kritika Kultura
Two Tales From
Somewhere Between
Two Worlds

Fiction

WRITING FELLOWSHIPS RECEIVED

Writing Fellowship
Type of
Fellowship
Iyas National
Fellow for
Writers Workshop
Poetry
(2010)

Cha Asian Literary Journal

URL (if available)

http://journals.ateneo.e
du/ojs/kk/article/view/K
K2014.02332/1917
http://www.asiancha.co
m/content/view/2216/52
2/

(Fill out if applying for Category A)

Organizer
Inclusive Dates
Bienvenido N Santos Creative
Writing Center of De La Salle
University

ESSAY
Why do you write?

How can your NAGMAC membership contribute to your writing?

25-30 April 2010

REQUIRED MANUSCRIPTS (per category):

Category A Advanced Level. For proof of attendance in writing fellowships, please provide the
certificate of attendance and/or workshop proceedings and/or a press release/news article from the
workshop organizer with your name as an accepted applicant.
For published works, attach printed (if publication is online) or photocopied/scanned (if publication is
print) image of the work together with this filled out application form.
2
Category B Intermediate Level. For published works, attach printed (if publication is online) or
photocopied/scanned (if publication is print) image of the work together with this filled out
application form.
3
Category C Beginner Level. For unpublished writers, submit original literary works: 5 poems (for
poetry) or 2 short stories or 1 novel synopsis (for fiction), 2 non-fiction narrative or literary essay (for
non-fiction), or 1 full-length play or 2 one-act plays (for drama).
1

By signing, you have agreed to the following:

(1) That NAGMAC, and its reviewers, has the right to disqualify my application if the documents
Ive submitted proved to be falsified; and
(2) That NAGMAC, as a writer community, has the right to collect an annual membership fee of
Php 200.
Signature above
Printed Name

Date Signed