Contact Info
Name:
Email:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Phone (day):
Phone (eve.):
Educational Background
College Degree(s)
Graduate Study Degree(s)
Other
Please indicate applicable programs
Writer Residency program (5 and 10 day)
A Picture’s Worth — A Thousand Words
Community-based programs (libraries, community groups, etc.)
After-school programs
Writing programs for business professionals

Picturing Poetry (a collaborative program with CEPA featuring poetry & photography

Why do you want to become a member of the Writers Corps?

Do you have experience preparing lesson plans and presenting to students?  Please describe any relevant teaching experience, indicating the grade levels or ages with which you have worked:

Do you have special skills or experience that would be valuable in this work or that you’d like to highlight?

Please indicate any preference for age/grade level
Are you proficient in a foreign language?

What is your availability for assignments (are you flexible, available certain days/times/seasons, etc.) and how much work would you like to do?
Have you ever been convicted of any crime? If yes, please explain
Please list two people we may contact as references for you:
Include Name, Phone, Address, Email


 
  
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