Writers in Residence Republic of Ireland: Application Form

Writers in Residence Republic of Ireland: Application Form
Name Of School*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Roll Number
School's Phone Number

Area CodePhone Number
School's email*
Teacher

First NameLast Name
Contact Email
Mobile Number

Area CodePhone Number
Proposed Writer
Class
Number Of Students
Number Of Sessions
Start Date*

MonthDayYear
End Date*

MonthDayYear
Focus of Project*
It would be useful if you could outline, as appropriate, any requirements such as special needs, ESL/EAL students, specific cultural sensitivities, recent bereavements or traumatic events
I can confirm that third party funding is in place*
Should the teacher be absent from the classroom for any reason during the writer’s visit, responsibility for any incident which may occur during his/her absence rests entirely with the school, and the school further agrees to indemnify the writer and/or Poetry Ireland Writers in Schools without limitation in respect of same.

Please read our financial terms and conditions
I have read, understand and agree to the above condition and financial terms*

Yes
Writers in Schools, Poetry Ireland, 11 Parnell Square East, Dublin 1

Phone: +353 1 678 9001 Email: education@poetryireland.ie
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