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Professional Level Workshop
Application Form

Please fill out all of the fields below. Use your browser's print button to print this form out and mail it along with four (4) copies of your manuscript submission to:

                          Attn: Screening Committee
                          John Oliver Killens Writers Workshop Inc.
                          399 Halsey Street, Suite 100
                          Brooklyn, NY 11233-1014

Please note your name should NOT appear anywhere on the manuscript!

* Date of Application:

* Name of Applicant :

* Home Address:

* Zip:

* City:

* State:


* Home Phone:

* E-mail:

* Name of Work Submitted :

If submission is part of a larger work

Name of Larger Work :

If submission is part of a larger work, is this the first chapter or does it appear somewhere else in the work?

Location in Larger Work :

* Brief Description of  Work:

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