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City of Rockford Poet Laureate Nomination

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City of Rockford Poet Laureate Nomination

Poet Laureate Nomination Form

"*" indicates required fields

Your Information

Your Name*

First Last

Your Address*

Street Address Address Line 2 City State ZIP Code

Your Phone Number*

Are you a member of the Rockford Area Arts Council?*

Yes

No

Are you self-nominating?*

Yes

No

Nominee's Information

Name of Nominee*

First Last

Nominee's Mailing Address*

Street Address Address Line 2 City State ZIP Code

Nominee's Email Address*

Nominee's Phone Number*

Is the Nominee a resident of Rockford?*

Yes

No

Statement of Agreement

Have you read, and agree to, the expectations of the Poet Laureate position?*

Yes

No

Verification of Understanding

As a nominator, have you contacted the nominated poet and verified that the poet has reviewed the expectations of the position and agrees to the nomination?*

Yes

No

Getting the Word Out

How did you hear about the Poet Laureate nominations?

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