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* 1. Primary Contact:

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* 2. E-mail Address:

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* 3. Institution name:

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* 4. Host institution type:

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* 5. Selected RoadShow:

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* 6. Your 1st choice workshop date would be:

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* 7. Your 2nd choice workshop date would be (at least one week apart)

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* 8. Your 3rd choice workshop date would be (at least one week apart):

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* 9. Has your institution *applied* to host a competitive, subsidized ACRL RoadShow in the past?

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* 10. Has your institution *been selected* to host a competitive, subsidized ACRL RoadShow in the past?

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* 11. Please indicate the number of participants you expect would attend and why. (Note: The minimum is 45 and maximum is 100. Evaluators will not penalize smaller institutions.)

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* 12. Statement of support from hosting authority (i.e. library director/dean, consortia/association administrator, or ACRL chapter leader. Copy and paste is fine; don't worry about original signatures being lost.)

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* 13. Brief statement explaining what the host institution will do after the workshop to maintain momentum, engagement, and education on their campus:

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* 14. I understand that, if selected as a host, we will share in the costs for this workshop by remitting $2,000 to ACRL.

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* 15. Is the host an organizational member of ACRL?

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* 16. Please provide details on types of library staff to be invited (i.e. liaison librarians, catalogers, access services staff, senior management):

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* 17. Please provide details on staff outside the library to be invited, if any (i.e. research office, graduate college):

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* 18. Other information for consideration?

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