Host Organization Application

Applications for Fall 2010 Together series are due May 15. Libraries applying for Spring will be notified by June 15.

Please review the Together—Book Talk for Kids and Parents overview and Common Questions before completing this application.

This form requires you to upload your scholar co-facilitator's resume in Word or PDF formats.

* indicates a required field

Host Site Information

* Name of Library

* Address

* City

* ZIP Code

Website

Host Site Coordinator

* Name

* Job Title

* Phone Number

Fax Number

* Email Address

Librarian Co-Facilitator (if different from above)

Name

Job Title

Phone Number

Email Address

Scholar Co-Facilitator

* Name

* Job Title

* Phone Number

* Email Address

* Scholar-Facilitator Resume

Word (doc) and PDF documents only. Files size must be under 1 MB.

* Briefly describe the families you plan to reach with this program. (E.g. Frequent library users, underserved populations, etc.)

* Please explain why you are interested in hosting a Together series at your library. What benefit do you think this program will have for your community?

* What space do you plan to use for discussion?

* What is your plan for childcare?

Please include any additional information that should be considered with your application.

* I understand and accept the conditions that Council-sponsored Together series must be free and open to the public as well as the requirement that Council support must be formally acknowledged on all printed materials related to the program. By submitting this form, I agree that the host site coordinator, the scholar co-facilitator, and the librarian co-facilitator will attend the mandatory training session.

* Please complete the following arithmatic so that we can be assured that this form is being submitted by a human.

6 + 6 =