Outreach Visit or Program Request Form

All outreach requests need to be submitted a minimum of 8 weeks before the event is scheduled. If your event is within the 8-week minimum you may still submit a request but attendance may not possible. Attendance at any event is up to the library’s discretion.

Name of Contact

First

Last

Organization

Phone

Email

Event Type

Bookmobile Visit

(home visit, facility visit, etc.)

Pop-Up Library

(library services including checkouts provided at your location)

Outreach Program

(Book clubs, crafts, literacy based activities, etc.)

Vendor Table

(Information, giveaways, etc.)

Other (please describe below)

Target Age Group for Event

Kids & Family

Teens

Adults

(Please select the PRIMARY age group for your event.)

Other

Event Description

Event Date

(If you do not have a specific date or time for the requested event please provide an estimate.)

Start Time

End Time

What time would you like us to arrive?

Event Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Where would you like the Bookmobile or Van to park?

(Please note: Our Bookmobile requires approximately 10 feet in height and 20 feet in length of clearance. A lift in the back can provide wheelchair accessibility if there is additional length for our space and a flat surface behind the vehicle.)

Specific types of materials to bring for the event

Bookmobile Visit

(book subjects/wish list, target age groups, etc.)

Pop-Up Library

(book subjects/wish list, target age groups, etc.)

Outreach Program

(book clubs, crafts, literacy based activities, etc.)

Vendor Table

(information and giveaways)

Are restrooms available to library staff?

Yes

No

Is a drinking fountain or free water available for library staff?

Yes

No

Is this an indoor event?

Yes

No

I acknowledge that by submitting this application, I am not guaranteed any specific times, dates, or requests. Approval of any programs or attendance at any events are up to the library’s discretion.