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Writers' Room 2025 - Registration and Sign Up
Please fill out and submit the following questions. If you need this form in another format please email creative.futures@hackneyempire.co.uk.
26
Questions
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1
Our Writers' Room Programme is for people aged 18-27. Writers' Room runs from Wednesday 22nd October - Wednesday 17th December. You MUST be available for all programme dates to join the company.
I am within the age range of 18-27 and can attend ALL programme dates
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2
Full name
*
This field is required.
First Name
Last Name
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3
What are your pronouns?
*
This field is required.
what you would like to be referred to as such as (she/her), (they/them), (he/him)
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4
Email address
*
This field is required.
We will contact you for confirmation and other information via email, please ensure to check your junk or spam folder if you haven't heard from us.
example@example.com
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5
Phone number
*
This field is required.
+44
Phone Number
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6
Date of birth
*
This field is required.
-
Date
Day
Month
Year
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7
Age
*
This field is required.
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8
Address
*
This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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9
What borough are you from?
*
This field is required.
e.g Hackney, Essex, Haringey
Hackney
Waltham Forest
Haringey
Islington
Redbridge
Newham
Enfield
Barking & Dagenham
Tower Hamlet
Barnet
Camden
Brent
Greenwich
Lewisham
Other
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10
Why would you like to take part in this project?
*
This field is required.
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quote
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11
Please submit a piece of your writing (no more than 400 words). It can be any form.
*
This field is required.
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12
Parent/guardian name
*
This field is required.
First Name
Last Name
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13
Phone number of your parent/guardian
*
This field is required.
+44
Phone Number
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14
Email address of your parent/guardian
*
This field is required.
example@example.com
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15
What is your relationship to this person?
*
This field is required.
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16
Do you live with this emergency contact?
*
This field is required.
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17
Please provide the name and phone number of a secondary emergency contact. This must be different to the person above.
*
This field is required.
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18
Do you live with this emergency contact?
*
This field is required.
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19
Do you consider yourself disabled/neurodiverse?
Please Select
Yes
No
Please Select
Please Select
Yes
No
If yes, please specify in the box
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20
Do you have any access requirements you would like to tell us about?
Is there anything Hackney Empire could provide to help you participate? For example, print outs on yellow paper or in large print, lift access or visual stories.
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21
Do you have any medical conditions or allergies we should be aware of?
*
This field is required.
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22
Is there anything else you would like to tell us?
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Ok
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23
Please select your gender from the list below.
Please Select
Male
Female
Prefer not to say
Transgender male/ masc
Transgender female/ femme
Gender fluid/ gender non conforming/ ungendered
Non-binary
Intersex
Prefer to self describe
Please Select
Please Select
Male
Female
Prefer not to say
Transgender male/ masc
Transgender female/ femme
Gender fluid/ gender non conforming/ ungendered
Non-binary
Intersex
Prefer to self describe
If other, please specify
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24
Ethnicity
We are using the descriptions set out by Hackney Council. If you feel more comfortable with another description, please fill it in the blank box.
Please Select
Aalbanian
Arab
Bangladeshi
Black African
Black British
Black Caribbean
Chinise
Roma/Gypsy
Indian
Iranian
Latin/South /Central American
Other Asian background
Other black background
Other Mixed background
Other White background
Pakistani
Traveller
Turkish
White and Asian
White and Black African
White and Black Caribbean
White British
White European
White Irish
Prefer not to say
Prefer to self describe
Other
Please Select
Please Select
Aalbanian
Arab
Bangladeshi
Black African
Black British
Black Caribbean
Chinise
Roma/Gypsy
Indian
Iranian
Latin/South /Central American
Other Asian background
Other black background
Other Mixed background
Other White background
Pakistani
Traveller
Turkish
White and Asian
White and Black African
White and Black Caribbean
White British
White European
White Irish
Prefer not to say
Prefer to self describe
Other
If other, please specify
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25
How did you hear about us?
Please Select
Web
Instagram
TikTok
Friend
Email
School
Teacher
Poster/Flyer
Other
Please Select
Please Select
Web
Instagram
TikTok
Friend
Email
School
Teacher
Poster/Flyer
Other
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26
Would you like to join the Creative Futures mailing list to hear about future projects and opportunities to take part in?
YES
NO
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