Program Proposal Form

Presenter’s name (or company/organization name):

Email:

Phone number:

Location of Presenter (city, state):

Program Title:

Description of program:

Primary Purpose of Program:
EducationEntertainmentHands-On LearningGroup DiscussionOther

What credentials do you possess that make you an expert on your proposed topic? (Examples: academic degrees, professional certificates, formal training).

Intended Age of Audience:
AdultChildren, PreschoolChildren, Grades K-5Children, Grades 6-12All Ages

Are you suggesting an in-person or virtual program?
VirtualIn-PersonEither

Do you charge a fee for your program?
YesNo

If yes, what is your fee?

Desired length of program:
30 minutes45 minutes1 hour90 minutes2 hoursLonger than 2 hours

Presentation Format:
Lecture with presentation (audience seating)Performance (audience seating)Workshop (classroom seating)Discussion (small group seating in a circle)Computer class (computer lab needed)Lobby Table (walk-up table)

Are you an author?
YesNo

If yes, please provide book title(s) and publisher.

Have you presented at other libraries or organizations in the past year?
YesNo

If so, please provide the name of the organization, your contact’s name, and their phone or email for the three most recent presentations that you have given:

I certify that the answers contained in this form are true and I understand that I will only be contacted by email if my program proposal is accepted.