Organization Name:

Primary Contact:

E-mail:

Phone:

Have you worked with UUAP before? Yes No

If yes, in what capacity?

If no, how did you hear about UUAP?

Type of Program:
choose one Cultural Dance Educational Forum Exhibit Performance Recreation Special Event UMix Late Night event Other

If other:

Program Description and History (in detail):

Program Goals:

Is this program already scheduled?
Yes: Date: Time: Location:

No: Preferred Date:

What kind of program assistance do you need? Mark all that apply.
Marketing Facility Assistance Advising/Program Planning
Program Management Other

If other:

Please explain.

Please describe your ideal partnership with UUAP.