Name of Organization: *Contact Person: *Organization Address: *Organization Phone: *Email *I acknowledge that my organization may not fall within the Kingsville Public Library's legal service area, but that does not prevent it from receiving KPL library services funded by the State of Ohio through the Public Library Fund, if a written request for Outreach Programming is made.Electronic Signature *Date *Which outreach programming services are you requesting? *Adult ServicesYouth ServicesTechnologyHow many attendees do you expect for this program? *1-56-1011-1516-2021-25Over 25What are the approximate ages of the attendees at this program? Check all that apply. Birth-33-56-1011-1315-18Over 18Where would you like this program to take place? *Kingsville Public LibraryVirtualYour Primary LocationOther Location*space availability at the library is dependent upon previously scheduled eventsEnter address if other location 1st Choice Date / Time *When would you like this program to occur?2nd Choice Date / Time *When would you like this program to occur?What services and activities are you interested in? Check all that apply. *Arts/CraftsMusic/Songs (Youth Services Only)Creative Drama/Puppets (Youth Services Only)Stories/StorytellingEducational EnhancementCricut (Adult Services Only)Makerspace (Technology Only)What themes, topics, or special interests would you like this program to focus on? Do any participants have special needs we can accommodate? NameSubmit
