Outreach Application

Organization Name*

Contact Name*

First Last

Contact Email*

Contact Phone*

What type of program are you interested in?*

Program Topics*

Please select all of the topics of interest for the program.

Do you have any specific speaker(s) of interest?

Area Served

What areas (i.e. counties, cities, regions, and/or states) would be served by this program?

Program Date*

When are you interested in holding the program?

Program Venue*

Do you have a preferred or suggested venue to hold the program?

Planning Committee

If you have board members, volunteers, and parents that would be interested in helping with the planning process, please list their name and relationship to your organization?

Do you expect any Spanish-speaking attendees?

Yes
No

Organization's Operating Budget*

Please select which best describes your organization's annual operating budget?

Program Charge for Attendees*

What would be an appropriate charge for this program that represents the socio-economic status of the families served?

Program Budget*

What is your allocated budget range for this program?

Once you submit your application, you will receive a confirmation to the email listed above. If you do not receive a confirmation email, please contact tamara@NDSCcenter.org. Applications are reviewed by the NDSC monthly.

Center for Outreach & Education