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Raiziss/de Palchi Fellowship Entry Form

The undersigned hereby submits the enclosed work to The Academy of American Poets for the Raiziss/de Palchi Fellowship, acknowledges reading the guidelines, and agrees to abide by them. (Please type or print.)

TITLE OF MANUSCRIPT  
AUTHOR  
TRANSLATOR  
ADDRESS  
CITY, STATE, ZIP  
 TELEPHONE  
 EMAIL  
PHONE NUMBER  
 SIGNATURE  
 DATE  

PLEASE PRINT AND SEND TO:

The Raiziss/de Palchi Fellowhip
The Academy of American Poets
75 Maiden Lane, Suite 901
New York, NY 10038

For more information, please contact:

Patricia Guzman
Programs Assistant
awards@poets.org
TEL (212) 274-0343 x13


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