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The Writer’s Studio and the Certificate in Creative Writing Application
Please complete this form and return with accompanying
documentation, and certificate application fee to:
Program Assistant
Writing and Publishing Program
Simon Fraser University at Harbour Centre
515 West Hastings Street, Vancouver, BC V6B 5K3
List below any courses you have previously taken from the
Writing and Publishing Program:
Or fax to 778-782-5098
Annual deadline to apply: October 26, 2009
❏ I also am applying to MFA programs
Two separate payments are enclosed for:
name (first)
(initial)
(last)
1. manuscript reading and evaluation fee of $50 (nonrefundable)
2. certificate application fee of $275 (application fees are processed only if
organization, if applicable
you are accepted into the certificate program.)
Payments are enclosed by:
title, if applicable
address
❏ cheques (two separate cheques payable to Simon Fraser University)
❏ VISA ❏ MasterCard
❏ business ❏ home ❏ other
city
province
day telephone
evening telephone
postal code
cardholder’s name (if different from applicant’s)
account number
email or fax
signature (mandatory if paying by credit card)
Please note that students in The Writer’s Studio must have an
email address.
Collection of Personal Information
Please submit in quadruplicate all of the following:
❏ a statement of why you think The Writer’s Studio is right for you
❏ a writing résumé detailing all your writing-related activities, including
reading groups, education, training and publications.
❏
20 pages of sample writing selected from the following genres:
• fiction
• personal narrative or creative non-fiction
• poety and lyric prose
The manuscript must be prepared according to professional
standards: double-spaced, typed on one side only, and with your
name, title and a page number on each page.
Samples of writing will not be returned.
expiry date
The University collects your personal information under the authority of the University Act
(RSBC 1996, c. 468, s. 27(4)(a)). The information is related directly to and needed by the
University to administer and operate non-credit programs, workshops and courses. The
information will be used to register you in the appropriate non-credit program, monitor
your academic progress and send you information about University programs. It will also be
used to issue certificates and diplomas for eligible students. If you have any questions or
requests about the collection and use of this information please contact Natalie Makortoff,
Coordinator, Continuing Studies, 515 West Hastings Street, Simon Fraser University,
Vancouver, BC V6B 5K3, 778-782-5077, wpp@sfu.ca.
Personal information collected by the University for non-credit certificate and diploma
programs is also related directly to and needed by the University to administer and operate
its alumni programs and services. The information will be used to register non-credit
certificate and diploma program graduates as members of the SFU Alumni Association. This,
and other information held by the University, will be disclosed to Alumni Relations and
University Advancement in order to inform you about the benefits of University and Alumni
Association career, educational and social programs; to provide you with information about
alumni products and services; to facilitate alumni participation in university research
projects, alumni surveys and fund raising and development activities; and, to administer
elections for university and alumni association governing bodies. The University may also
disclose this information, under strict confidentiality agreements, to outside agencies solely
for the provision of mailing or telephoning services on behalf of the University or the Alumni
Association. If you have any questions or requests about the collection, use or disclosure of
this information, contact the Director of Alumni Relations, Simon Fraser University, Burnaby,
BC V5A 1S6, telephone 778-782-4154, email alumni@sfu.ca, or visit the Alumni Association
website at www.sfu.ca/alumni/.
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survey
Completion of the following is optional. The information obtained here is for the use of Continuing Studies only.
We do not share or make available any information to other organizations.
o Male
o Female
Education after high school, including professional training:
o Bachelor’s degree _ _______________________________________
Major_______________________________________________________
o Master’s degree __________________________________________
Program of study______________________________________________
o Doctoral degree _ ________________________________________
Program of study______________________________________________
o Diploma _ ______________________________________________
Area _ ______________________________________________________
o Certificate_ _____________________________________________
Area _ ______________________________________________________
o Other courses or writing programs (please specify): __________________________________________________________________________
Have you completed any other institution’s creative writing courses, programs, workshops, etc.? (e.g., Booming Ground, Humber College, Banff) If so,
please specify: __________________________________________________________________________________________________________
Has your work been published? If so, please specify: _____________________________________________________________________________
Age group:
o 19-25 o 26-35 o 36-45 o 46-55 o 56-65 o 65+
What is your professional position/work? __________________________________________________________________________________
Your industry/organization? _______________________________________________________________________________________________
How did you first hear about the Writing and Publishing Program?_________________________________________________________________