1 Application for Songwriting Challenge and Poetry Out Lou

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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. Full legal name*

2. Mailing address, including zip code*

3. Email address*

4. Home or cellphone number*

5. Grade*

6. School name*

7. How did you learn about the Songwriting Challenge or Poetry Out Loud?

   1. Through my school

   2. Through an afterschool or out of school program

   3. A friend

   4. An article online or in print

   5. Local Arts Agency

   6. Facebook

   7. Twitter

   8. Instagram

   9. 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 co-written 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 :

1. Which character is singing this song?

2. Who is this character singing to?

3. What is the time and place of the story?

4. What inspired this song?

12. Provide the name and lyrics of the song: (text box)*

13. Certification and permissions Y*

    1. 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)

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.)

• 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.)

• 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.

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: webmgr@arts.gov, 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