EmailMe Form - EXCELLENCE IN LIBRARY SERVICES APPLICATION

Program Title *

Personal ALA Member #

Library *

Name *

Prefix First Last Suffix

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone

### - ### - ####

BRIEF DESCRIPTION OF LIBRARY: *

1,000 characters maximum for all descriptive fields

BRIEF DESCRIPTION OF TEEN POPULATION IN COMMUNITY: *

BRIEF DESCRIPTION OF PROGRAM: *

PURPOSE/GOAL OF PROGRAM: *

DESCRIBE BRIEFLY HOW THE PROGRAM EXEMPLIFIED ONE OR MORE OF YALSA’S NATIONAL GUIDELINES, TOOLS OR COMPETENCIES (found at www.ala.org/yalsa/guidelines): *

DURATION OF PROGRAM: *

BRIEF DESCRIPTION OF TARGET AUDIENCE: *

Attendance (Number of Tweens, Teens, Parents/Caregivers, and Others in Attendance):

Tweens

Teens

Parents/Caregivers

Others

PARTNERS/COSPONSORS:

Name All Partners

YOUTH PARTICIPATION:

(what role did the TAG or teen volunteers play?) *

BUDGET FOR PROGRAM (Please provide a dollar amount for each category):

Speaker’s expenses (fee, travel, meals, other)

Supplies and equipment (materials, purchases, rentals, other)

Refreshments (incl. paper products)

Collection development (books & other materials to support/enhance the program)

Staff time (organizer’s hours x wage, PR staff hours x wage)

Public relations (fliers, poster, bookmarks, press releases, mailings, postage)

Swag (prizes, incentives, giveaways, door prizes)

Other costs (e.g. security or police for traffic detail)

FUNDING SOURCES: *

Select all that apply
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If other, please describe:

EQUIPMENT & SUPPLIES USED: *

PUBLICITY AND PROMOTION: (please select all that apply) *

Select all that apply
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If other, please describe:

ACCOMPANYING RESOURCES: *

Select all that apply
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If other, please describe:

EVALUATION:

Describe the evaluative measures that were used to determine the success of the program. *

What made the program successful? *

What elements of the program made it innovative, unique or creative? *

What unforeseen challenges did you encounter, if any? What recommendations or best practices will you consider for future programs of a similar nature? *

*

I certify that to the best of my ability, all of the information I have provided in this application is truthful and accurate.