Form 1 Applications from Students for Agency Intitiatives Poetr

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DATA FIELDS FOR SONGWRITING CHALLENGE /POETRY OUT LOUD/INITIATIVES FOR YOUTH
APPLICATION FORM QUESTIONS
NOTE: All asterisked (*) items on this form are required and must be completed before you will
be able to submit the form. Do not type in all capital letters when completing the form.
1.
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Full legal name*
Mailing address, including zip code*
Email address*
Home or cellphone number*
Grade*
School name*
How did you learn about the Songwriting Challenge or Poetry Out Loud?
a. Through my school
b. Through an afterschool or out of school program
c. A friend
d. An article online or in print
e. Local Arts Agency
f. Facebook
g. Twitter
h. Instagram
i. Other

NOTE: If the song or poem is co-written by two students, please provide the above information
for both students.
8. Is your submission an original song or poem that you have written by yourself or cowritten with another high school student? Y/N*
9. Has this song or poem ever been professionally produced or distributed? Y/N*
10. If you become a finalist, are you and your writing partner (if applicable) available to
travel with a chaperone to the event? Y/N*
11. Musical theater songs are an important part of a musical; they can drive the plot, bring
settings or characters to life, or otherwise engage the audience through a staged
theater production. In order to better understand your song, and how it fits in to a
musical theater story, please share with us, in the box below in 3,000 characters or less:
a) Which character is singing this song?
b) Who is this character singing to?
c) What is the time and place of the story?

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d) What inspired this song?
12. Provide the name and lyrics of the song: (text box)*
13. Certification and permissions Y*
a. By selecting "yes" above, I state my intention to participate in the Songwriting
Challenge or Poetry Out Loud competition and certify that the work I upload is
entirely my own. I will submit the appropriate permission form, available under
the heading "Permissions," before DATE at 11:59pm ET.
Upload items:
• An audio file of the song (required). The audio file can be of any length and a maximum
of ten minutes. However, the panelists who are judging your application will only listen
to a maximum of 5 minutes from the song. Acceptable file types are mp3, wma, wav,
aac, mid, midi, mpa, and ra.*
•

The music score or sheet music for the song (optional). PDF format only.

•

A video file. (.mov or .mp4)
Songwriting Challenge only:
Instructions for Video File Submission (Maximum of two minutes in length):
We are excited for the opportunity to hear from you in a brief introduction video. Tell
us a little more about yourself in your own words. This is your chance to speak directly
to the panelists who will review your application. Videos should be no longer than 2
minutes in length. Please do not worry about this video looking “professional.” We
encourage you to record it at home on your phone or computer (so long as we can
clearly hear and see you.) Alternatively, you may submit this information in a one-page
PDF.
Here are some sample question prompts you can include in your video (or written
statement):
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How would you describe your songwriting style/sound?
What inspires your writing?
Do you have a favorite musical, composer, or songwriter?
What are you most excited about for this program?
What do you hope to take away from this experience?

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Poetry Out Loud only:
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How has participating in Poetry Out Loud changed your relationship with poetry?
What is something that you learned about yourself—or in general—from
participating in Poetry Out Loud?

The National Endowment for the Arts collects basic descriptive information about all applicants.
The information that follows will be used to evaluate the effectiveness of the NEA’s outreach
program to reach all students. Your responses are optional and will not be a factor in the
review of your application.
Ethnicity (Optional/Pick One.)
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Hispanic or Latina/o: A person of Hispanic, Latino, or Spanish origin; may be of any race.
Not Hispanic or Latina/o

Race (Optional/You may choose more than one.)
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American Indian or Alaskan Native: A person with origins in the original peoples of N./S.
America.
Asian: A person with origins in the original peoples of the Far East/SE Asia/Indian
subcontinent.
Black or African American: A person with origins in any of the black racial groups of
Africa.
Native Hawaiian or Other Pacific Islander: A person w/origins in orig. peoples of
HI/GU/Samoa/Pac Is
White: A person with origins in the original peoples of Europe, the Middle East, or North
Africa.

Privacy Act
The following notice is furnished in accordance with the Privacy Act of 1974, 5 U.S.C. 552a:
This information is solicited under the authority of the National Foundation on the Arts and the
Humanities Act, 20 U.S.C. 951 et seq. and is used to for the purpose of application review.
Personal data including home address and home telephone number will not be released and is
exempt from disclosure under FOIA exemption (b)(6). Failure to provide the requested
information could result in rejection of your application.

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Paperwork Reduction Act Statement
The public reporting burden for this collection of information is estimated at an average of one
hour per response. This includes the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. We welcome any suggestions that you might have on improving the
guidelines and making them as easy to use as possible. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to: [email protected], attention: Reporting Burden. Note: Applicants are
not required to respond to the collection of information unless it displays a currently valid U.S.
Office of Management and Budget (OMB) control number.
OMB CONTROL NUMBER: 3135-0137

EXPIRATION DATE: TBD