Please submit this survey by June 3, 2016

* 1. Name

* 2. Department or Program

* 3. Please read the description of the Institute on the website [https://dartmouthwritinginstitute.wordpress.com/institute/] and then describe here your interest in participating in this Institute (no more than 250 words).

* 4. Availability (check all that apply; please note that you will be welcome to stay for lunch at 12 each day)

* 5. Any additional comments or thoughts?

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