Outreach Request Form Outreach Request Form * indicates a required field Name * Required First Last Email * Required Enter Email Confirm Email Phone * RequiredOrganization Name * RequiredOrganization Type * Required Daycare K-12 School Youth Camp College/University Government Agency Senior Center Festival Local Business Religious Institution Other If other, please nameEvent Location * Required Street Address Address Line 2 City ZIP Code Expected Number of Participants * RequiredMinimum 20 requiredAudience Group * Required All Ages Babies (0-24 months) Youth (2-5 years) Youth (Grades 2-5) Youth (Grades 6-8) Youth (Grades 9-12) Adults Seniors Preferred Date and TimeSpecify the date and time of the event or list your top three dates with times if the event has not yet been scheduled.Specify any accessibility needs or other special requests.Is free parking provided? * RequiredYesNoWhat service do you want us to provide? * Required Library Card Drive Books for Babies Program: Baby Storytime for parents and babies 0-24 months Storytime Program: Themed stories, rhymes and songs for kids Youth STEAM Program: various materials available. See Outreach Information Page Adult STEAM/Maker Program: various materials available. See Outreach Information Page Bring Your Own Device Program: Learn how to use library resources on your device Business Resources: Learn how to use business, marketing and entrepreneur resources available through the library Book Discussion Group Adult Innovation Station Youth Innovation Station Other If other, please describeIf you selected the Innovation Station van for your outreach visit, please confirm that your location has adequate parking (dimensions: 24' (length) x 8' (width) x 10' (height), plus extra room to get in and out easily. Yes No In what type of space will your program be situated? * Requiredindoors, outdoors, small room, larger room, gymnasium, festival, etc.How many sessions would you like the library to offer?Will staff from the host agency be present during the program?If you are requesting a STEAM program with a group of children or teens, the presence of a reasonable amount of staff from the hosting agency is required. Yes No Will you complete an outreach survey after your program or visit? * Required Yes, I will complete a survey after my program.PhoneThis field is for validation purposes and should be left unchanged.
