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Nomination Form

1) Your Information

Name: ________________________________________

IWP Program Afiliation: __________________________

Date: __________

Nominating or which program? ____________________

2) Candidates General Information

Name: ________________________________________

Country: _______________________________________

Age: ______ Gener: ______

Are!!: ______________________________

______________________________

______________________________

Phone: _______________________________

"mail: _______________________________

#o$%Proe!!ion: ________________________

Pre&iou! 'ra&el: ________________________

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"ngli!h (anguage Pro)ciency: *"+cellent *Goo *Poor*None

3) Candidates Writing Career,plea!e )ll out a! $e!t a! you can-

Genre,!-: *)ction *poetry *play! *critici!m *tran!lation!*other ____________________________________

Nota$le Pu$lication! ,plea!e gi&e the "ngli!h title! an the genre oeach title-:

1)

2)

3)

4)

5)

'ran!lation! o wor. into other language! ,plea!e !tate the "ngli!htitle an the language! it ha! $een tran!late into-:

1)

2)

3)

4)

5)

Awar! an /onor!:

7/25/2019 Writer Nominations for Future Residencies.rtf

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Comment!: