Program Proposal Form – NORTHVILLE DISTRICT LIBRARY

Date / Time

Date

Time

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Organization Name

Website / URL (if applicable)

Title of Program *

Program Description *

(please provide brief description of your program)

Program Length *

Age of Intended Audience *

Check all that Apply

Program Type *

Time of Day *

Budget *

We do have a limited budget for programming. Note your expectations for payment. If none, enter "None".

List other Library/Organizations you have presented this program for, include who, where and when.

You can list multiple locations.

Equipment Requirements *

(laptop computer, DVD Player, projector, sound system, etc.)