This is a wonderful prompt that allows even your most reluctant readers to reflect on poetry and its values. I often begin class by reading a poem (ranging from silly to serious) and having the student use this assignment as a journal of their thoughts.
It contains several sentence prompts to head off any writer's block. It also contains a rubric worked right into the worksheet for student reference. Golden!
Can be easily adapted for any poem at any grade level (although the wording is best suited for grade 5 and up)