ODYSSEY ONLINE CLASSES
STUDENT APPLICATION

COURSE INFORMATION
Class that you are applying for:   

CONTACT INFORMATION
Last name:
First Name:
Middle Name:

Address:
City:
State:
Zip:
Country:
Home phone:
Cell phone:

EDUCATION
List the most recent schooling first, and then previous schooling:
School (1):  
Location:
Major:
From (MO/YR):
To (MO/YR):
Degree:
GPA:

School (2):  
Location:
Major:
From (MO/YR):
To (MO/YR):
Degree:
GPA:
 
 Additional training, workshops, and seminars attended:
 






WRITING HISTORY
Publications, awards, and memberships:





Describe your development as a writer.  How would you describe your skills at this point?  What would you like to learn from Odyssey's online classes?  What are your writing goals? (500 words max)
















What unpublished works have you written?
Title (1):
Genre:
Length:

Title (2):
Genre:
Length:

Title (3):
Genre:
Length:

Title (4):
Genre:
Length:

Title (5):
Genre:
Length:

EMPLOYMENT
Company:
Address:
Title:
Dates:    From (MO/YR):     		To (MO/YR):
Duties:
Phone:

REFERENCES
List two persons familiar with your writing:
Name/Title:
E-mail:
Phone:

Name/Title:
E-mail:
Phone:

WRITING SAMPLE
Provide a writing sample here of 1,000 words maximum:
 
 
 












SUBMISSION OF APPLICATION
Please check one of the following:

_______ I will pay my $10 application fee via PayPal (see bottom of application page).  

_______I am sending my $10 application fee as a US check or money order via regular mail. 

_______I am an international student and am sending my $10 application fee as an international money order in US dollars. 

I certify that the above information is correct and complete to the best of my knowledge.  I authorize investigation of all statements contained herein and the references listed above to provide Odyssey with any pertinent information.
 

Electronic Signature (Type full name):
Date:	
Email Address: