3135-0112 Literature Supplemental Information Form

OMB No. 3135-0112
Expires 11/30/2013

Literature Fellowship Application

Supplemental Information
Applicant (legal name):

Mr.

First:

1.

If applicable, Pen Name:

2.

Birth Date:

3.

Category under which support is requested:

/

Ms.

Last:

/

Translation Projects (check one):
Prose

Poetry

The project is a (check if applicable):

Drama
Collaboration

Retranslation

Specify language:
Fellowships for Creative Writers (check one):
This category operates on a two-year cycle with fellowships in fiction and creative nonfiction available one year and
fellowships in poetry available the next; check the guidelines to verify the cycle.
Fiction

Creative Nonfiction

Poetry

4.

Education:

NAME OF INSTITUTION

5.

MAJOR AREA OF STUDY

DEGREE

Present Employment
Employer:

6.

INCLUSIVE DATES

Position/Occupation:

Fellowships, grants, and awards previously received (list any previous Arts Endowment grants first):

NAME

AREA OF STUDY

INCLUSIVE DATES

AMOUNT, IF
APPLICABLE