Girls Write Now Enrollment 2021-22 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 2021-2022 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 State
Please 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 Borough
Please 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 Background
Please 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 Grade
Please 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 State
Please 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 Status
Please select...
Full-time
Part-time
Self employed
Unemployed
Retired
Student
Employment Sector
Please 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 Type
Please 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 non-conforming 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 nonconforming 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 non-conforming 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 nonconforming 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:
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Contact Information