EmailMeForm
Program Proposal Application
Required fields are marked with a red asterisk(*)
Contact Information
Contact Name:
*
First
Last
Email:
*
Phone:
###
-
###
-
####
Mailing Address:
Street Address
City
State / Province / Region
Postal / Zip Code
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.)
Presenter/Instructor Name:
First
Last
Email:
Phone:
###
-
###
-
####
Mailing Address:
Street Address
City
State / Province / Region
Postal / Zip Code
Program Information
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: (Select any that apply.)
*
Kids & Families
Birth to 6 years old
Elementary school
Middle school
High school
Adults (ages 18+)
Seniors
All
To select multiple age groups hold down the CTRL key and select each group.
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 "n/a" is 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 you 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 in 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
