U.S.

Embassy in Cairo
2015 Between the Lines: International Writers Program
Chaperone Contact Information Coversheet
Biographical Information
Full Name (exactly as written in passport):
Title:
Employers Name:
Gender:
Date of Birth (mm/dd/yy):
City of Birth (exactly as written in passport):
Country of Citizenship:
Country of Residency:
ID/Passport Number:
Home Address:
Home Phone:
Mobile:
E-mail:
Previous international travel:
Writing residencies and conferences attended:
List of Publications (if any); please include the genre of each
publication (e.g., poetry, novel, essay, short story collection) and an
English translation of the title:
Summary of translations of work in other languages; please give
specifics for those works translated into English:
Awards and Honors (if any):