Poetry Caravan Application  (Please Print)

 

Date: __________

 

Name: ______________________________________

 

E Mail address__________________________

 

Phone Number:s:  Home __________________  Office __________________  Cell _____________________

 

Home Address: ____________________________________________________________________________

 

Genre of Primary Interest: (check one):

            (   )Reading poetry of established Poets           (   )Reading own poetry

            (   )Combination of own/established poets        (   )Writing Workshop

 

 

Preferred venues (check as many as applicable):

Nursing homes                         (    )                  Hospitals                                  (    )

WomenÕs Shelters                    (    )                  Community Centers                  (    )

Prisons                                     (    )                  Therapeutic Communities         (    )

 

Preferred times: (Circle all applicable)   Weekdays                    (a.m.)               [p.m.]

                                                                        Saturdays                    [late a.m.]         [early p.m.]

                                                                        Sundays                      [late a.m.]         [early p.m.]

 

Comments:________________________________________________________________________________

 

Will you need transportation?  __________

 

Comments on other requirements:______________________________________________________________

 

Why do you want to join the Poetry Caravan?  (Please write several sentences)

 

 

 

 

 

 

 

Poetry Background: (can include publication credits, performance history, awards, teaching background, strengths); attach separate sheet if necessary: Please attach at least 3 sample poems.

 

 

 

 

 

 

 

 

 

 

Equipment Required: (i.e. microphone, overhead projector, paper/pens) and comments:

 

Send this application and the poems to the Poetry Caravan, care of:

 Ruth D. Handel: RuthHandel@verizon.net or 3 Gilmore Court, Scarsdale, NY 10583

or Frank Sisco:  ideasmoney@aolcom or 30Mill Road, New Rochelle, NY 10804