Young and Published Application Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which tier are you in?
*
Tier I (13-18)
Tier II (19-26)
Academic Information for Tier I Applicant (Skip if you are Tier II)
Grade or Year Level
*
Date Expected to Graduate
*
-
Month
-
Day
Year
Date
Are you a member of any organization in your school? Please provide information.
*
Are you a member of any organization outside your school? Please provide information.
*
Education Information
Name of School
*
School Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Book Information
Name of Book
*
Book Genre
*
Please Select
Fiction
Nonfiction
Poetry
Book Description
*
Why do you want to be an author?
*
Please upload a sample of your COMPLETED book. (Sample must be 3 Full chapters.)
*
Browse Files
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I AFFIRM THAT ALL STATEMENTS I HAVE INDICATED HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY MISREPRESENTATION I HAVE MADE CAN CAUSE FOR THE INVALIDATION OF MY APPLICATION AND SHALL BAR ME FROM RE-APPLYING FOR THE SAME.
Applicant's Signature
*
Acknowledgement
*
I acknowledge that if I do not have a COMPLETE draft of the book that I am submitting, my application will be invalid.
Date Signed by Applicant
*
-
Month
-
Day
Year
Date
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