BIPOC Authors Support Form

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Do you identify as a member of the BIPOC (Black, Indigenous, and People of Color) community?

Please indicate your specific background or community affiliation (optional)

What is your current role as an author?

Other

Tell us about your manuscript or project (genre, stage, brief summary)

What type(s) of support are you seeking? (Select all that apply)

Please describe your previous writing or publishing experience (if any)

Preferred support format

How did you hear about this support program?

Additional comments or specific needs

Signature (please sign below to confirm your application)