Student First & Last Name *

First Name

Last Name

When is your birthday?

MM

DD

YYYY

What's your phone number? *

(###)

###

####

What is your race/ethnicity? *

African-American/Black

Latino/Latinx/Mestizx

Asian/Pacific Islander

Caucasian/White

Native American/Indigenous

Middle Eastern/Arab

Bi-racial/Multiracial

Other

What is your gender? *

Female

Male

Nonbinary

Transgender

Two-Spirit

Other

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

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 chose 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 $47,520 per year or if a family of four earns wages less than $97,200 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 encourage all applicants to read a book (or article) by bell hooks, Octavia Butler and Audre Lorde. Can you commit to doing this by the program start date?

Yes

No

Maybe

How you do 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.

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

Justice4Sister Twitter

Justice for My Sister Facebook

Other social media account

Other organization

Los Angeles Department of Cultural Affairs

Other

Program Cost: The cost of the 8-week lecture series is $555. We are offering a limited amount of partial scholarships, based on need. Select an option:

Please select one option

I am able to pay the $555 tuition fee to partake in the Lab and will render payment to Justice for My Sister by October 28, 2022

I would like to request a partial scholarship, and will attend all workshop sessions and commit to finishing a draft of my script by January 2022. I will render payment of $250 to Justice for My Sister by October 28, 2022

Terms and conditions *

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

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.