Program Proposal Application
Contact Name
*
First Name
Last Name
Contact - Email
*
example@example.com
Contact - Phone Number
Please enter a valid phone number.
Contact - Address
Does the presenter represent a private business, non-profit, ...?
*
Yes
No
Presenter Information - same as Contact Information above?
*
Yes
No
(If no please complete Presenter Information fields below.)
Presenter/Instructor Name
First Name
Last Name
Presenter - Email
example@example.com
Presenter - Phone Number
Please enter a valid phone number.
Presenter - Address
*
Program Title (may be altered)
*
Detailed program description (Please note, presentations cannot include any form of solicitation or product/service promotion)
*
If proposing a structured class (e.g. a computer class), please detail your prepared class outline or syllabus)
Intended learning outcomes for attendees (what will attendees learn/gain/produce)
Presenter's qualifications (Please list education/degrees, training, certifications, and/or experience the Presenter possesses that makes them qualified to present on this topic, or links to websites that show your experience or work)
*
Intended age group
*
Kids and families
Birth to 6 years old
Elementary school
Middle school
High School
Adults (ages 18+)
Seniors
All
(There is a $100 flat fee to use any Library A/V equipment. A/V is only available Monday through Thursday)
Program duration
*
One hour
Two hours
Three hours
Other
Set-up time needed
*
30 minutes
One hour
Two hours
Other
If this program is a series, how many programs do you propose?
Describe your preferred date/time/day of the week?
*
Maximum attendance or registration limit for your program
*
Equipment or supplies needed, including A/V or furniture (enter 'NA' if none)
Space needed (describe any specific size or room features necessary)
Are you requesting a speaker/performance fee?
*
Yes
No
If yes, please describe your fee
Have your or your group presented a program at the Bedford Public Library before?
*
Yes
No
If yes, please describe your previous program(s) with dates
References (i.e. contacts from other libraries or organizations where you've presented the past)
*
Please provide any additional information to help us evaluate your program proposal.
I have read and agree to comply with all of the items in the Library's Programming Guideline, should my program proposal be accepted.
*
Yes
No
Please verify that you are human
*
Submit
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