Poetry is Power Teen Institute
Teen Participant Questionnaire

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:
June 21st from 10 am - 2 pm
June 24th from 10 am - 2 pm
June 26th from 10 am - 2 pm
*June 28th from 5 - 7 pm - This is the celebratory poetry reading, open to family and friends to attend.*

Location:
The Garcia Center for the Arts
536 W 11th St, San Bernardino, CA 92410

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.

Free, healthy meals and snacks, and writing materials will be provided for all participants. 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 *
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Last Name *
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Street Address *
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City *
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Zip Code *
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Phone number *
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Emergency Contact Name *
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Emergency Contact - Phone Number *
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Emergency Contact - Email Address *
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How old are you? *
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What grade will you be entering in the 2019-2020 school year? *
What are your gender pronouns? *
Why are you enrolling in Poetry is Power Teen Institute this summer? *
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What are you interested in exploring in the genres of poetry and creative writing? *
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What do you hope to gain as a participant in Poetry is Power Teen Institute? *
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Can you attend all of the dates for PIP Teen Institute: June 21th-June 28th from 10 am - 2 pm on Mondays, Wednesdays and Fridays? If not, please let us know of any scheduling conflicts; however, your participation and commitment are essential to this program. *
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What is your favorite book? What do you like to read? *
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What is your favorite film, or TV show? *
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Do you have any allergies, food or otherwise? *
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Do you have a special diet? *
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Do you need special accommodations for PIP Teen Institute? If so, please list them here. *
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Do you require financial help with public transportation to get to the Garcia Center? *
Is there anything else about yourself that you’d like to share? *
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