Teacher Registration

inspiring high school students through the spoken word

Poetry Out Loud Teacher Registration

Deadline: December 3, 2021
Please complete this form in its entirety. After we receive your completed registration form, a Poetry Out Loud Teacher Guide will be sent to you. It is important that we receive all the information requested. You can preview an online tool kit at www.poetryoutloud.org

For additional information about Poetry Out Loud please contact:
Maryjane Dorofachuk-POL State Coordinator
mdorofachuk@nevadaculture.org
Phone: (702)486-3738
Fax: (702)486-3887

Teacher's Name*
First Last
School*
School Address*
Street Address Address Line 2 City State ZIP Code
Email Address*
Phone Number*
Principal's Name*
First Last
What type of classes will be participating? *Check all that apply**
- General English Language Arts
- Advanced or AP English
- Drama/Theatre
- Poetry Course
- After-School Program
- In-School Program
- Virtual School
- Home School
- Other
What is the name of the class?
How many of your students do you anticipate to participate in this in this program?*
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