DISQUIET 2023 application form
Use this form to apply for DISQUIET 2023 (June 25-July 7, 2023).
Sign in to Google to save your progress. Learn more
First name *
Last name *
Gender (optional)
Date of birth *
Use the format MM/DD/YYYY
Additional notes
If applicable: preferred name, writing name, anything else you'd like us to know
Biography
Provide a short bio if you like.
Website
Optional: if you have a website you'd like us to visit, drop the URL here
Additional web presences
Optional: if you want us to know where to find you on social media or elsewhere, you can use this box.
Profession
Optional: What do you do for a living?
Alumni year
Have you attended DISQUIET in the past? Check all years that apply.
Email *
Please provide an email address where you can be reached through July 2022. (We will not publically display any contact information)
Mailing address *
Where you can be reached through July 2023; please include postal code and country
Phone number *
Emergency Contact Name *
Emergency Contact Relationship to You
Emergency Contact Address
Emergency Contact Phone Number *
Please include country codes
Emergency Contact Email Address *
Emergency Contact Additional Information
Provide additional emergency contacts or ways of getting in touch with your emergency contact, if you want to.
Physician/Medical Care Provider Name *
Please provide the name of a physician or other medical care provider in case of a medical emergency while abroad.
Physician/Medical Care Provider Email and/or phone number *
Please provide contact information for a physician or other medical care provider in case of a medical emergency while abroad.
Core Workshop Selection *
Please select all that apply. If you have multiple genre interests but prefer one over the others, please note your preference order under "Additional notes" below.
Required
Additional notes or questions
Optional: If there's anything you'd like to add or ask, please use the space below
If you have a preferred author to workshop with, please state his/her name here:
We'll begin announcing 2023 faculty later in October, and will notify applicants of any changes. Placement is subject to availability.
Optional, informal Tues/Thurs. workshops will be announced to all applicants at a later date. Meanwhile, please select one of the below:
Requested roommate
If purchasing housing from DISQUIET. We'll do our best as availability permits.
Payment
Use the form at http://disquietinternational.org/the-program/cost-deadlines/ to pay the $20 application fee. Please paste the transaction number you recieve from Paypal into this space. If you are unable to use the form, please contact disquietinternational@gmail.com
Writing Sample
Please send one writing sample of 15 pages or less (or up to 5 poems) in each genre for which you'd like to be considered. Writing samples should be attached files (.docx, .rtf., .pdf, or .odt), sent to disquietinternational@gmail.com with "2023 Application" in the subject line.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms