Girls Write Now Inquiry Form Girls Write Now Enrollment 2022-23 Inquiry Form Thank you for your interest in Girls Write Now! Please complete this form to receive the application and more information on our programming once enrollment for the 2022—2023 program year opens.Learn more at girlswritenow.org/enroll. Contact & Personal Information Your interest in Girls Write Now (check all that apply):I am interested in being a Mentee (must be between 12 and 23 years old)I am interested in being a Mentor (must be 23 years of age or older)I am an educator, interested in Girls Write Now programming for my students First Name Last Name Title Grade you teach (if not applicable, put N/A)Please select... 8th 9th 10th 11th 12th Other Subject you teach (if not applicable, put N/A): Email address: Phone number: Home City Home StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Guam American Samoa Palau Zip Code Home BoroughPlease select... Bronx Brooklyn Manhattan Queens Staten Island Demographics We continue to prioritize serving a diverse group and cultivating an inclusive network, and therefore respectfully request demographic information. This information will be used solely used for planning purposes to ensure we serve communities most impacted by the current realities in this country. Racial/Ethnic BackgroundPlease select... African American/African/Black Asian/S. Asian/Asian Amer./Pac. Islander Caucasian/White Hispanic/Latinx Middle Eastern Native American/American Indian/Alaskan Bi-Racial/Multi-racial Other If other, please specify: Age range:Please select... Under 18 18-23 24-30 31-40 41-50 51-60 61 - 70 70+ Do you identify as LGBTQA+?Please select... Yes No I prefer not to answer School Information School Name Current GradePlease select... 8th 9th 10th 11th 12th Some College College Graduate Gap year Anticipated Graduation Date What type of school do you attend?Please select... Public School Specialized School Charter School Private School School Information School Name School Street Address School City School StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Guam American Samoa Palau School Borough School Neighborhood School Zip Code Are there additional colleagues at your school who should also be notified once our enrollment opens?Please select... Yes No How many of your colleagues would you like us to notify?Please select... 1 2 3 4 5 More than 5 Are there specific students you would like us to notify once our enrollment opens?Please select... Yes No How many of your students would you like us to notify?Please select... 1 2 3 4 5 More than 5 Colleague 1 Name of colleague 1: Title of colleague 1: Email address of colleague 1: Phone number of colleague 1: Colleague 2 Name of colleague 2: Title of colleague 2: Email address of colleague 2: Phone number of colleague 2: Colleague 3 Name of colleague 3: Title of colleague 3: Email address of colleague 3: Phone number of colleague 3: Colleague 4 Name of colleague 4: Title of colleague 4: Email address of colleague 4: Phone number of colleague 4: Colleague 5 Name of colleague 5: Title of colleague 5: Email address of colleague 5: Phone number of colleague 5: If you have more than five colleagues you would like us to share information about Girls Write Now once enrollment for the 2021-22 program year opens, please email their name(s), title, and contact information to mentee@girlswritenow.org. Student 1 Name of student 1: Grade student 1 will enter next year:Please select... 9th 10th 11th 12th Gap year College Graduate school Other If other grade, please specify: Email address of student 1: Phone number of student 1: Student 2 Name of student 2: Grade student 2 will enter next year:Please select... 9th 10th 11th 12th Gap year College Graduate school Other If other grade, please specify: Email address of student 2: Phone number of student 2: Student 3 Name of student 3: Grade student 3 will enter next year:Please select... 9th 10th 11th 12th Gap year College Graduate school Other If other grade, please specify: Email address of student 3: Phone number of student 3: Student 4 Name of student 4: Grade student 4 will enter next year:Please select... 9th 10th 11th 12th Gap year College Graduate school Other If other grade, please specify: Email address of student 4: Phone number of student 4: Student 5 Name of student 5: Grade student 5 will enter next year:Please select... 9th 10th 11th 12th Gap year College Graduate school Other If other grade, please specify: Email address of student 5: Phone number of student 5: If you have more than five students you would like us to share information about Girls Write Now once enrollment for the 2021-22 program year opens, please email their name(s) and contact information to mentee@girlswritenow.org. Employment Information Employment StatusPlease select... Full-time Part-time Self employed Unemployed Retired Student Employment SectorPlease select... Advertising Architecture Book Publishing Corporate/Technical Writing Design Education Fashion Film/Video Information Technology Journalism Music/Audio Magazine Publishing Marketing/Public Relations Newspapers Online Media Radio Social Media Software Television Visual/Performing Arts Other Occupation Title If other employment sector, please specify Company TypePlease select... Individual Corporation Government Non-Profit/Association School or University Other Name of Company/Organization you are currently, or most recently worked Program Which of our programs would you like to apply to? If undecided, we encourage you to explore both programs at girlswritenow.org/mentee and select the program below that best suits your needs.Writing 360: Life is better in twos! Girls Write Now's writing and multimedia mentorship program is open to young women and gender-expansive youth in high school. Mentees form a one-to-one mentoring relationship with a professional writer, explore multi-genre, multimedia writing taught by leading experts, build a portfolio, and perform and publish original work—with mentors supporting every step of the way! Mentees in this program also have access to all Writing Works workshops and programming.Writing Works: In Girls Write Now’s college and career readiness program, mentees work with professionals, who act as their “mentors for the day”, while also having access to a broad range of resources, events, and opportunities. Writing Works is open to girls and gender-expansive youth in high school, college, or in between. Mentees receive support with college essays, scholarships, internships, and professional writing across a broad range of industries from publishing and advertising to entertainment, finance, and beyond. This program is less rigorous and less of a time commitment than Writing 360. Undecided Which of our programs are you interested in for your students? If undecided, we encourage you to explore both programs at girlswritenow.org/mentee and select the program below that best suits your student's needs.Writing 360: Life is better in twos! Girls Write Now's writing and multimedia mentorship program is open to young women and gender-expansive youth in high school. Mentees form a one-to-one mentoring relationship with a professional writer, explore multi-genre, multimedia writing taught by leading experts, build a portfolio, and perform and publish original work—with mentors supporting every step of the way! Mentees in this program also have access to all Writing Works workshops and programming.Writing Works: In Girls Write Now’s college and career readiness program, mentees work with professionals across industries who act as their “mentors for the day” while also having access to a broad range of resources, events, and opportunities. Writing Works is open to girls and gender-expansive youth in high school, college, or in between. Mentees receive support with college essays, scholarships, internships, and professional writing across a broad range of industries from publishing and advertising to entertainment, finance, and beyond. This program is less rigorous and less of a time commitment than Writing 360.Undecided Which of our programs would you like to apply to? If undecided, we encourage you to explore both programs at girlswritenow.org/mentor and select the program below that best suits your needs.Writing 360: Life is better in twos! Mentors in this program form a one-to-one relationship with a young woman or gender non-conforming youth throughout the year, explore multi-genre, multimedia writing taught by leading experts, and support their mentees in developing their work for portfolio, publication, presentation, college applications, and other opportunities.Writing Works: In Girls Write Now’s college and career readiness program, young women and gender non-conforming youth work with professionals across industries who act as their “mentors for the day.” Writing Works mentors provide support with college essays, scholarships, internships, and professional writing across a broad range of industries from publishing and advertising to entertainment, finance, and beyond.This program is less rigorous and less of a time commitment than Writing 360. Undecided Relationship to Girls Write Now How did you hear about Girls Write Now?Please select... Attended a Girls Write Now event Teacher or Guidance Counselor Family Member Friend or colleague After-school Fair Social Media Internet Search Another program I am involved in Other Please share the name of the person who told you about Girls Write Now: Please share the name of the program: If other, please describe: Please Note: By submitting this form, you will be subscribed to our general mailing list and can unsubscribe at any point. Contact Information