THE AUTHORS LEAGUE FUND
Established by The Authors League of America, Inc.
155 Water Street, #206 • Brooklyn, NY11201• Tel 212.268.1208 • Fax 212.564.5363
Application
We provide non-taxable assistancetoauthors, dramatists, poets, and journalistsin times of emergency. Your information is confidential and notshared outside the organization.Submit this application by email, fax, or mail. We will follow-up by email unless you indicate that you do not have access.For eligibility guidelines and FAQs, visit
Identification:
NAME: ...... AGE: ......
STREET ADDRESS: ......
CITY: ...... STATE: ...... ZIP CODE: ......
TELEPHONE: ...... E-MAIL: ......
DEPENDENTS, WITH AGES: ......
CURRENT OR FORMER MEMBER OF THE AUTHORS GUILD(Not required for assistance): ......
TO WHAT OTHER ORGANIZATIONS, GUILDS, OR UNIONS DO YOU BELONG? ......
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Financial Information:
PLEASE LIST INCOME—AMOUNTS AND SOURCES—FORCURRENT AND PREVIOUS YEAR(E.g., earned income,advances/royalties, Social Security, Disability, pensions, support from family, friends, charitable organizations, state/federal agencies): ......
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IS YOUR SPOUSE/PARTNER EMPLOYED(If applicable)? ...... HIS/HER INCOME: ......
DO YOU RENT? ...... MONTHLY RENT: ......
DO YOU OWN? ...... MONTHLY MORTGAGE PAYMENT: ......
LIST YOUR ASSETS:
A. Checking/Savings Accounts: ......
B. Investments/Retirement Savings: ......
C. Real Estate/Mortgage: ......
D. OtherAssets: ......
E. Social Security, Disability, or Unemployment? ...... Amt. per Month: ......
F. Have you: Private health insurance?(Include premium cost) ...... Medicare/Medicaid? ......
DESCRIBE ANY DEBTS(Include required monthly minimum payments):......
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Career Information:
LIST ALL PUBLISHED BOOKS, ARTICLES, STORIES, POEMS, AND PLAYS WITH TITLE, PUBLISHER, AND YEAR. FOR DRAMATISTS, LIST PRODUCED OR PUBLISHED PLAYS, STATE WHETHER ONE-ACT OR FULL-LENGTH, INCLUDE PRODUCTION DATE(S) AND THEATER NAME(S), OR PUBLISHER AND YEAR. ALL APPLICANTS:FEEL FREE TO USE A SEPARATE PAGE OR APPEND A CV/RESUME. INCLUDEAWARDS/HONORS:......
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CURRENT WRITING PROJECT: ......
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PUBLISHER/ADVANCE: ......
DO YOU WORK OUTSIDE THE WRITING FIELD? IF SO, IN WHAT FIELD(S)?......
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Additional Information:
HOW DID YOU HEAR ABOUT US? HAVE YOU PREVIOUSLY BEEN ASSISTED BY THE FUND OR ANOTHERWRITERS’ ASSOCIATIONS(E.g., PEN, Dramatists Guild)?...... PROVIDE A DETAILED DESCRIPTION OF YOUR EMERGENCY (Using additional pages is encouraged): ...... AMOUNT REQUESTED:......
EXPECTATIONS FOR REPAYMENT: ...... SIGNATURE/NAME: ...... DATE: ......