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Program Proposal Form


Program Proposal Form
Program Administrator
 
First Name
M.
Last Name
Program Proposed
 
Program Description
Program Description
 
Please provide a detailed write-up

Dates/Times Requested
Requested Start Date
 
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Requested End Date
 
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Requested Start Time
 
(hh:mm am/pm)
Requested End Time
 
(hh:mm am/pm)
Space Requested (optional)
Space Requested
 
Equipment Required
Equipment Required
 
Please list any materials or equipment required

Target Audience and Distribution
Target Audience and Distribution
 
What ages is this program for and how would you like the information distributed?

Enrollment Information
Enrollment Info - Min
 
Minimum Number of Participants

Enrollment Info - Max
 
Maximum Number of Participants

Staffing
Staffing
 
All staff must complete a CORI form at least 3 weeks prior to the start of any program

Requested Salary
Requested Salary
 
If different from the established rate of $40 an hour

Suggested cost of the program and what does it include?
Suggested Cost
 
Price Includes
 
Any additional Information
Additional Info
 
Please list any additional information you would like us to request on the registration form. (ie t-shirt size, required equipment, etc.)