ORGANIZATION NAME: (Please provide the name of the organization and/or project):

 

CONTACT NAME /  ADDRESS / PHONE:

 

 

CONTACT EMAIL ADDRESS:

 

DESCRIPTION OF PROJECT: (Please provide a description of the project in 100 words or less, including the Organization's mission and project objectives.

 

 

 

 

 

NUMBER OF CHILDREN TO BE SERVED (Please provide details of the audience, including age and other relevant information):

 

 

LENGTH, FREQUENCY AND LOCATION OF PROGRAM (For example, "This six-week program will meet twice a week from 2:00 to 4:00 at NCC

 

 

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REQUEST TO PROGRAM WITH Norwalk Reads!