• Title of the poem:
  
  
  
  Patron is: ____ sure ____ guessing
  
  
• Author:
  
  
  
  
  Patron is: ____ sure ____ guessing
  
  
• First line:
  
  
  
  
  
  Patron is: ____ sure ____ guessing
  
  
• Any other lines or phrases:
  
  
  
  
  
  
  Patron is: ____ sure ____ guessing
  
  
• Theme of poem: The patron may know the sense of the piece even if the words are not remembered.
  
  
  
  
• Type of poem:
  ____Children's ____Bawdy ____Humorous ____Religious
  
  
• Parody of (name original work)
  
  
  
  
• Inspirational
  
  
• Holiday (specify which one)
  
  
• Other
  
  
• Source:
  • From where does your patron remember it?
    
    
  • From a TV show?
    
    
  • From childhood?
    
    
  • Be as specific as you can.
    
    
    
    
    
• Possible Date: Does your patron have any idea how old the poem might be?
  
  
• Any other information or clues:
  
  
  
  
  

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This page was updated December 2, 2003.