City of Cupertino, CA | Poet Laureate Application

*Full Name

*Residential Address

*Daytime Phone

Evening Phone

*Cupertino Resident / Employer

Resident Employee

*Email

Employer (if applicable)

*Cupertino Address

Please check one for each of the following:

I am at least 21 years old

YesNo

I am an active poet and have been published or been publicly recognized for my contributions to poetry

YesNo

I am the sole creator of the attached poems

YesNo

I am a resident or currently employed in Cupertino for at least 2 consecutive years OR I have demonstrable ties to the City of Cupertino

YesNo

I am comfortable speaking in public. If speech impaired, I may delegate reading tasks to qualified speaker

YesNo

If you answered “no” to any of the above questions, you are not eligible to be appointed Cupertino Poet Laureate.

*Three-to-five original poems (published or unpublished)

Choose file (Poem 1)

Choose file (Poem 2)

Choose file (Poem 3)

Choose file (Poem 4)

Choose file (Poem 5)

(Provide atleast three poems)

*Current Resume

Choose file (Resume)

*Two Letters of Recommendation or References

Choose file (Reference 1)

Choose file (Reference 2)