Student Poetry Submission Form - Walt Whitman Birthplace Museum

First Name

Last Name

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home / Cell Phone

School Name

School Address

School Address Line 2

School City

School State / Province / Region

School Postal Code

School Country

School Phone

Teacher's Name

Teacher's Email

Anthology

Yes No

Title of Poem

Upload your poem:

Poem Title and Entrance Category, Student Name, Student Address, Student Phone Number, Student Email, Age, Grade, School Name, Teacher Name, Teacher Email

For Anthologies Only - Student / Teacher Name

First

Last

Upload Anthology

– Student/Class Poem(s) – Anthology Title Sheet with Entrance Category, Teacher name. Grade, Class Period, School Name, School Address, School Phone, Teacher Email
Student Name must be on each individual poem – 30 line Maximum Submit in Book Form

Multi-Media - Category L

Upload Multi-Media

Declaration

I declare that all material(s) submitted is(are) my own work and does not involve plagiarism and/or artificial intelligence.