Listening to every heart
Personally, I'd either hold onto that one, or give an explanation about the source format if you choose to include that one in your submitted collection of personal scribbles.
Good advice. But "format", I believe, would be open - insomuch as one could [probably not] copyright the format of a sonnet, or free verse, etc.
However, a word to this publisher that "this particular format" stemmed from [this person] would not hurt. At least he would know you're up front!
Because, your own I Am poems are just that. Your poems.
Good luck, Ringo!