Application Form

Please read all the instructions carefully before proceeding.

Use only permanent blue or black ink.

If you have special needs that require accommodation,

please explain.

The information you provide should not be limited

by the space allowed.

If you require more space, append another sheet of paper.

In the blanks below please provide us with the following:

 

your family name, your surname, your given names.

In the spaces provided below please list your middle name,

your married name, your maiden name.

         Please write your name exactly as it appears.

Do not neglect to include the names

of your clan, your forefathers, the name that is known

for miles around your ancestral home as synonymous

with a high-ridged nose, a scholarly bent, a particular

branch of expertise.

                                  If more space is required, append

another sheet of standard-size paper.

Please print clearly the names your mother rehearsed

while you wriggled for leeway inside her.

In the blanks below,

                                  fill in the schoolyard spit-ringed

slurs and concocted superhero monikers.

What handle foiled the forum’s pingbacks?

Whose incognito initials bit into bark?

What property was signed away to the sand?

What petition was authored by indignation?

What name did you blurt in your sleep, the one

you never betrayed? What epithet couldn’t fly

past the watchtower; couldn’t be sounded

safely by patrols on night duty? Please release

your traceable aliases. Don’t limit yourself

to the space provided. In the forms and voids

intended for this express purpose. Please give us details

that will identify you and facilitate this process.