Organization Name
First Name (required)
Middle
Last (required)
Title
Address (required)
Address 2
Address 3
City (required)
State/Province
ZIP/Postal Code
Country
Phone
E-mail (required)
Organization Web Site
Organization Mission/Purpose
Have you worked with ALA or libraries before? Yes No
Name
Date of contact (required, format as mm/dd/yyyy)
Proposed activity (required)
Target audience
Geographic reach Select expected geographic reach Regional State National International
Term of commitment Select the term of commitment 1 Month 6 Months 12 Months 18 Months 24 Months 30 Months 36 Months Other
Start date (required, format as mm/dd/yyyy)
End date (required, format as mm/dd/yyyy)
Status of other involved parties, if any
Describe benefit to libraries
Describe benefit to the ALA
Describe benefit to requesting organization
Describe benefit to library visitors/target audience
Describe effort required by libraries, target audience, ALA staff and members
Describe financial resources available to support this activity
Request is for Select purpose of Request Collaboration/Partnership Distribution of program Funding Other
Response needed by (required, format as mm/dd/yyyy)
