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Independent Study & Research Request
Library Program Request Form
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Your Name:
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Library Name (or other organization):
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Mailing Address (please include city, state, zipcode)
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Program Site Address (if different than mailing address)
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Phone Number:
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Email
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What dates are you interested in? (Please list 3 possible dates)
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What time would you like the program to start? (Programs are typically 50-60 minutes, but can be shortened upon request.)
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Approximate ages and/or grades of children attending
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Approximate number of children attending
*
What program topic do you want DHNC to present?
*
Douglas-Hart Nature Center will contact you by email or phone within a few business days of receiving your program request.
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