North Carolina Poetry Society
Gilbert-Chappell Distinguished Poet Series
Student Application Form

Refer also to the Distinguished Poet Series Guidelines.

Name of Student Poet:   [Please include address, email, and phone number]


School Name (Private, Public, or Home):   [Please include address, email, and phone number]


Grade Year:

Name a poetry instructor [please include address, email, and phone number]
at your school who will write a recommendation for you:


Please ask this instructor to write the recommendation and to include an acknowledgement
that the instructor has read and understands the GCDP Series guidelines on the North Carolina
Poetry Society web site at   www.ncpoetrysociety.org/dpsguidelines.htm

Representative Poetry:   Send three pages of your poetry that you feel represents your work.

Mail your application by including your personal statement, representative poetry, and
your instructor’s recommendation to the Regional Committee appropriate for your county.
Please send these in the same mailing in order to expedite the review process. Thanks.

To identify the region appropriate for your county, see DPS Guidelines - List A.

To identify the Regional Committee (West, Central or East), see DPS Guidelines - List B.

If you have questions, contact Bill Blackley ( wjblackley@gmail.com ).
     Bill is the NCPS Gilbert-Chappell Distinguished Poet Series Chairperson.