Name *

First Name

Last Name

When is your birthday?

MM

DD

YYYY

What's your phone number? *

(###)

###

####

Have you or your family ever experienced any of the following? Check all that apply

Gender based violence

Racial discrimination

Incarceration

Foster care

Undocumented or citizenship status in transition

Workplace discrimination

Microaggressions

Homelessness

Veteran or Military Service

None of the above

Other

Choose not to answer

Have you ever experienced any of the following? Check all that apply. *

A sensory impairment (vision or hearing)

A mobility impairment

A learning disability (e.g. ADHD, dyslexia)

A mental health disorder

I have an impairment, disorder, or disability that I choose not to specify

None of the above

Other (please specify below)

According to Covered California income guidelines and salary restrictions, if an individual makes less than $20,783 per year or if a family of four earns wages less than $43,056 per year, then they qualify for government assistance based on their income. Is your family low-income? *

Yes

No

Choose not to answer

If selected, I commit to attend all sessions that BIPOC Sci-Fi Screenwriting Lab convenes at the times and dates described in this application form. *

Yes

No

Maybe

We require all applicants to read (or listen to) “Parable of the Sower” by Octavia Butler prior to November 19th. Can you commit to doing this by the program start date? *

Yes

No

Maybe

How do you describe your experience in the film, TV, news or entertainment industry? *

Novice/Beginner - I have not made a film or written a script.

Student - I have written a script and/or made a film that’s been publicly exhibited.

Entry-level - I have some experience on professional film sets as a PA or assistant.

Entry-level - I have experience as a writer’s PA, assistant, or researcher.

Freelancer - I have a specific trade that I live off of (production, DP, sound) but I haven’t written a script.

Mid-career Writer/director - I have written and directed films that have been broadcast and/or won awards.

Industry professional who has 5+ years experience.

Other

I have taken a screenwriting class before. *

Yes

No

Maybe

How did you hear about this workshop series? *

Friend

Previous fellow

Website

Justice4Sister Instagram

Justice for My Sister Facebook

Other social media account

Los Angeles Department of Cultural Affairs

Other organization

Other

To participate in the program you need to agree with our terms and conditions *

Select all you agree with

I understand that Justice for My Sister is working with a panel of readers to review applications, and there is a chance I might not be selected, due to limited capacity.

I agree that all the information I have provided is transparent, representative and true. I have voluntarily submitted my own original material to Justice for My Sister for the sole purpose of review for acceptance to the BIPOC Sci-Fi Screenwriting Lab.

I agree to complete the post survey provided by JFMS staff upon completion of the program.

If accepted, I agree to Justice for My Sister publishing my logline, bio and headshot photo to announce my participation in the Lab once I’ve completed my onboarding process.

I understand that upon completion of the lecture series, I am eligible to apply to Phase 2 for additional mentorship, and this is contingent upon review from a selection committee.