IPL Program Request Form
IMPORTANT: The Iberia Parish Library Programming Department will be in contact with you upon review if they decide to pursue the program further. Please note that turning in the form does NOT guarantee that your program will be accepted. You may also email supplemental materials that are related to the program. (I.E. video, photographs, letters of recommendation) to iberialibrary@gmail.com.
**Note: If you are submitting a Request form for a craft or arts project, a photograph or scan of the craft/art must be emailed. No exceptions.
The subject header for the email should be the title of your proposed program and your/ your organizations name.
Requesting Individual/Organization/Group *
Your answer
Contact *
Your answer
Email *
Your answer
Physical Address *
Your answer
Telephone *
Your answer
Fax
Your answer
Title of Program *
Your answer
Anticipated Audience (#) *
Your answer
Target Audience (age range appropriate for program) *
Required
Instructor/Speaker Topic(s) Proposed (If you have additional program requests, please fill out an additional form.) *
Your answer
Instructor/Speaker Credentials *
Your answer
Program Description *
Your answer
Length of Program (I.E. 1 hour, 2 1/2 hours, etc...) *
Your answer
Set-Up Time Required (I.E. 30 minutes, 1 hour, etc...) *
Your answer
Supplies/Equipment Required *
Your answer
Fee/Cost & Explain (if no fee or cost, answer N/A) *
Your answer
Have you presented this program (or similar programs) elsewhere? *
If so, please state where and which program
Your answer
Days available for program (Please Provide several available days.) *
Required
Times available for program (please provide several available times.) *
Your answer
Preferred Branch Location(s) *
Required
References that we may contact to inquire into your proposed program and credentials
Your answer
Thank you for your interest in collaborating with your Iberia Parish Library.
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