Poetry is Power Teen Institute
Teen Participant Questionnaire

***May 11, 2020 UPDATE: Poetry is Power will be hosted online this year, due to the global health crisis.***

Poetry is Power Teen Institute is the only free poetry and creative writing teen institute aimed at serving young people in the Inland Empire, and specifically in San Bernardino.

The dates are:
Week 1: July 7, 9, 10 from 11 am - 1 pm PST
Week 2: July 14, 16, 17 from 11 am - 1 pm PST
*July 19th from 4 - 6 pm PST - This is the celebratory poetry reading, open to family and friends to attend.*


Young people will participate in courses on spoken word, comics poetry, poetic form, and the institute will culminate in a public reading and collaborative performance, in addition to a published anthology.

The mentor faculty who will be teaching this summer are award-winning and critically acclaimed poets and authors, in addition to junior faculty who are studying creative writing in local colleges and universities.

Poetry is Power Teen Institute is sponsored by the Literary Laureate and Inlandia Institute.
First Name *
Last Name *
Email *
Street Address *
City *
Zip Code *
Phone number *
Emergency Contact Name *
Emergency Contact - Phone Number *
Emergency Contact - Email Address *
How old are you? *
What grade will you be entering in the 2020-2021 school year? *
What are your gender pronouns? *
Why are you enrolling in Poetry is Power Teen Institute this summer? *
What are you interested in exploring in the genres of poetry and creative writing? *
What do you hope to gain as a participant in Poetry is Power Teen Institute? *
Check the following writing workshops you’d be interested in taking: *
Can you attend all of the dates for PIP Teen Institute (See above)? If not, please let us know of any scheduling conflicts; however, your participation and commitment are essential to this program. *
What is your favorite book? What do you like to read? *
What is your favorite film, or TV show? *
Do you need special accommodations for PIP Teen Institute? If so, please list them here. *
Would you like support and resources with accessing technology (i.e. internet access) for Poetry is Power? *
Is there anything else about yourself that you’d like to share? *
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