Cracked Walnut
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Workshop Facilitator Survey
*
Indicates required field
Name
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First
Last
Current City/State
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Phone Number
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Are you a person of color? (We seek diversity in all of our programs)
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Email
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Are you a member of The League of MN Poets?
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Yes
No
Please acknowledge that you understand if you are not a member of The League of MN Poets, a donation of $25 to Cracked Walnut will be required. However, you may charge for your workshop and contribute from these funds.
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Acknowledged
What type of Poetry Workshop would you like to do? (please give a brief overview)
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Tell us about your experience facilitating workshops or classes? (Include dates, length of class/workshop, etc)
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Degrees & Licenses (Type "NONE" if none)
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What is your age?
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18 - 20
21-27
28-37
38-50
50+
Which age ranges have you taught or facilitated for? (select all that apply)
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4-10
11-14
15-18
19-25
25-45
46+
Any Additional Comments
*
Submit
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