Please complete the following questions as fully as possible, then click on the "Submit Query" button at the bottom of the page. The application will be sent directly to the Coordinators of Continuing Education.

Questions about grants may be directed to Mary Ross, Coordinator of Continuing Education.

Name of program or project: 

Admission cost: WLA member:   Non-member: 
   (note - a distinction between member and non-member fees is required)

Date(s) event to be held:   

Location(s):                


Contact person:
     Name:            
     Street address:  
     City:             State:  WA Zip: 
     Telephone:        Fax: 
     E-mail:          

Purpose or summary of presentation:


Name and background/qualifications of presenter(s):


Needs assessment conducted:
     CE Committee Survey
     Survey of WLA membership
     Other (please describe) 
Who is the primary audience?


Estimated number of participants:  

What will participants be expected to learn?


How will the program be evaluated?
     CE Committee Evaluation Form
     Test
     Narrative comments
     Other (please describe) 

BUDGET:
     INCOME:  Registration fees - 
                    WLA Members 
                    Non-Members 
	
              Estimated Number of Participants - 
                    Maximum     
                    Minimum     
          
                    *Note: Please estimate income based on minimum number of
                     participants. Budget registration fees accordingly.

                    *Remember to include a $2 per registrant charge to cover
                     ADA accommodation contingencies.
	

     EXPENSES: Please outline expenses below. Indicate with an asterisk
               (*) items to be paid from WLA CE funds. Indicate source(s)
               of other funding where applicable.

               Advertising:                       
                (Remember to include estimated costs for printing and postage)

               Food and site accommodations:      
                (Include room and equipment rental fees, costs for
                 refreshment breaks as needed)

               Registration and materials costs:  
                (Include photocopying costs for handouts, evaluation
                 forms, agendas, etc.)

               Program:                           
                (Include fee for presenter(s), air fair and other      
                 transportation costs, hotel and per diem.)
          
               Other Expenses:

               



     TOTALS:

          Total funds requested (expenses):                     

          Total income expected (based on minimum attendance):  

          Note: If expected income does not match or exceed total funds requested, 
                please explain (e.g. other funding sources or in-kind contributions)