New Program Application Form
a. This form needs to be filled one month in advance before the program starting date
b. Flyer to be delivered (2 – 3) weeks before the event. If program admin is not providing one, request for flyer should be sent a month in advance
Email address *
1. Application Date *
MM
/
DD
/
YYYY
2. Program Subject *
Your answer
Program Admin Info
3. Program Administrator Name (First, Last) *
Your answer
4. Program Administrator Cell phone *
Your answer
5. Program Administrator Email *
Your answer
Teacher/Speaker/Presenter Info
In case of multiple teachers, please separate their info by comma in the same field
6. Presenter Name (First, Last) *
Your answer
7. Presenter Cell phone *
Your answer
8. Presenter Email *
Your answer
Program Dates
9. Program Duration (in Days or Weeks) *
Your answer
10. Program Starting Date *
MM
/
DD
/
YYYY
11. Program Ending Date *
MM
/
DD
/
YYYY
12. Program schedule (Example: Every SAT and Mon from 1-2PM) *
Your answer
Audience Targeted
13. Language to be used *
Required
14. Gender *
Required
15. Age Group *
Required
16. Max number of attendees to register *
Your answer
17. Rooms/Classes needed *
Your answer
Program Details
18. Program objectives *
Your answer
19. Program Success Evaluation Metrics (Pass/Fail Exams, Quizzes, attendance only,..) *
Your answer
20. Program facilitation needed from the administration
21. Is a flyer ready for the program to promote the event? (if program admin is not providing one, request for flyer should be sent a month in advance) *
22. Any Event marketing recommendations
Your answer
Costs
23. Suggested payment to Presenter/Teacher/Facilitator ($) *
Your answer
24. Suggested cost per student ($) *
Your answer
25. Estimated cost of materials ($) *
Your answer
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