Young Adult Literature Application

To apply, fill out the information below as fully as possible. Once we receive your application, we will email you instructions for the actual registration process.

Name:
Birth date:
(For Identification purposes only)
Any other name that you may have taken a class under (i.e., maiden name)
Mailing Address:
Telephone:
E-Mail:

School Name:

School Address:
School Telephone:
School Fax:
School District:
Grades/ Subjects Taught:
Where did you hear about this program?

If you have questions about the application process or about any aspect of this course, contact Tom Thompson at phone: 843-953-1418, fax: 843-953-1881 or LWP@citadel.edu (email).