District Poetry Out Loud Winner Form

Please complete this form by 5 p.m. on Friday, February 5, 2010.

District winners who are not registered by this deadline will not be allowed to compete in the North Carolina Poetry Out Loud State Semifinals or Finals.


Student Contact Information:

*Name:

*Address:

*Email:

*Phone (home):

(format:000/000-0000)

Phone (cell):

(format:000/000-0000)

*Grade Level:

*Age:

School Information:

*English Teacher:

*School Name:

*School County:

*Principal:

*Superintendent:

*Superintendent Address:


*N.C. State Legislative Members from District:

(See this Web site for names of your assembly members. Students and teachers are
encouraged to write to their legislators thanking them for supporting Poetry Out Loud.)

Parent/Guardian Information:

*Name:

*Address:


Email:

Phone (home):

(format:000/000-0000)

Phone (cell):

(format:000/000-0000)

Phone (work):

(format:000/000-0000)


Chaperone Information:

Please fill out information for the student's chaperone to North Carolina Poetry Out Loud Semifinals and Finals on Saturday, March 6, 2010, if different from Parent/Guardian above.

*Name:

*Address:


Email:

Phone (home):

(format:000/000-0000)

Phone (cell):

(format:000/000-0000)

Phone (work):

(format:000/000-0000)


Poetry Selections:

At the North Carolina Poetry Out Loud Competition, students must have three poems prepared from www.poetryoutloud.org/poems or the official Poetry Out Loud print anthology. One poem must be 25 lines or fewer, and one must be written before the 20th century. The same poem may be used to meet both criteria. The order in which the poems are recited is up to the student.

Please list the titles and poets of three selections from to be performed at the North Carolina Poetry Out Loud Semifinals and Finals in the order in which they will be performed.

Title Poet Pre-20th Century? 25 lines or fewer?
1.
Yes
Yes
2.
Yes
Yes
3.
Yes
Yes

Biographical Information:

Please answer the following questions.

1. What is your favorite poem or who is your favorite poet, and why?

2. What interests you about poetry?

3. What have you learned from doing Poetry Out Loud? What was the most fun thing about it? (Or the scariest!)

4. Do you think this experience will affect other things in your life? If so, how?

5. In what extracurricular activities do you participate?

6. What are your three favorite things to do?

7. What are your aspirations for the future?

8. What is your philosophy of life?