Program Proposal Form

Your Full Name

First NameLast Name

Your Organization (if applicable)

Organization or business website (if applicable)

Type of organization

Other

Your Email Address

example@example.com

Your Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Your Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Presenter's Expertise/Credentials

Proposed Program Title

Proposed Program Description

Primary Intended Audience for Program

If you are presenting a program for children or teens does the presenter have all required clearances? (child abuse, criminal history check, FBI)?

How long is your program? (e.g. 45 minutes)

This program works best as

Proposed dates and times (please keep in mind some of our programming schedules run 3-6 months ahead).

How will registration be handled?

Required Resources and Equipment

Have you presented this program at other libraries? If yes, please share where you have presented and provide contact information for references, if possible.

Please share any other details about you or your program.

Upload a flyer for your event if you have one you would like us to use.

I have read the mission statement and program policy and my proposed program is in line with both.