Form Center

2. Presenter Proposal Form
   Do you have a program you would like to pitch to us? Please fill out the form below and your information will be sent to the correct staff members. Thank you!
4. Your Name*
5. Email Address*
7. Mailing Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Fax Number
16. URL
20. Program Name*
22. Target Audience of Program*

    1. Children
    2. Teens
    3. Adult/Seniors
    4. Family
23. Length of Program

    1. 30 minutes
    2. 45 minutes
    3. 60 minutes
    4. 90 minutes
    5. 120 minutes
24. Would you be willing to offer this program for free?

    1. Yes
    2. No
26. Program Description (Please provide a detailed description of the program, including lesson plan/agenda, program format, any hands-on activities, audience participation, etc.)
28. What will the audience gain or learn from attending this program?
29. Briefly state your background as it pertains to this program
33. Have you preformed at the Trumbull Library or the Fairchild-Nichols Memorial Branch Library before?

    1. Yes
    2. No
34. If Yes, what most recent date and which location?
35. Please provide two references that have used your performance services or are familiar with you professionally: Name, phone #, and email, and in what capacity do you know this reference? *
37. Is there anything you would like to add that would help guide the library in deciding on your application? (links to videos or photos of performances, lesson plans including learning outcomes, etc.)
39. By marking below, I acknowledge that I understand and agree to the following, if this application is accepted: *

    * I have qualifications (education, degree, experience, etc) that allow me to present this program. * I will not solicit directly to individual libraries, librarians, or participants. * I will not sell merchandise or services at any of the programs without the library's express consent. * I will provide my own equipment or supplies for my program. * Even if my program is approved, there is no guarantee of booking. * I may be interviewed and/or required to demonstrate the program.

    1. Yes
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field