Presenter or Program Proposal Form

Your Name

Email Address

Have you previously presented at CCPL?   Yes No

Select the type(s) of presentations or programs you are proposing.

  Facilitating a hands-on program
  Leading a demonstration-only program
  Presenting as a speaker or author
  Presenting a virtual program

What program topic(s) are you interested in speaking about or teaching?

What related experience or qualifications do you have?

Do you have teaching or instructional experience? If so, describe and include ages.

What times are you available to present?

  Weekday mornings
  Weekday afternoons
  Weekday evenings
  Saturday mornings
  Saturday afternoons

Program title and description

What are the learning objectives

Maximum Participants    5 10 15 20 25 50 75 100 125 150

Age Range    All Ages Adult (18+) Teen (11 - 17) Kids (8 - 10)

Program length    1 hour 1 1/2 hours 2 hours 3 hours 4 hours

Estimated cost per participant    $5.00 $7.50 $10.00 $15.00 $20.00 $25.00 $30.00 $35.00 $40.00 $45.00 $50.00

Are there other costs associated with this program?

What resources will you provide?

What resources (supplies/software) will Exploration Commons need to provide?

What facilities or equipment will this program require?

  Teaching Kitchen
  Classroom
  Large Meeting Room
  AV Lab
  AR/VR Lab
  Laser Cutter
  CNC Machine
  3D Printers
  Vacuum Formers
  Sewing Machines
  Laptops

If you are presenting a program based on your published work, please provide the following:

Title  

Publisher/Distributor  

Publication/Release Date  

ISBN/ISAN  

Any other information you would like to share?

The following authentication helps prevent spam.