Community Book Discussions Application

You must make arrangements with the facilitator, and with AHC for available titles, before submitting this request. For titles and contact information of a facilitator, please contact Erica Nunn by calling 602-257-0335 X26 or
e-mailing enunn@azhumanities.org.

Have you confirmed the program date, time and title with
each facilitator?* Yes

Applicant Information

Organization Name:
Are you an eligible applicant? Yes No
Address:
City:
State:	ZIP:
Phone:	Fax:
E-mail:
County:
AZ Legislative District:*	Congressional District:*
To find districts based on address, click here.
Person to contact about this form:
Address:
City:
State:	ZIP:
Phone:	Fax:
E-mail:

Book Discussion Program

List the program details here.
Date:	Time:	Facilitator:	Book Title:


Program Location (including street address):
Estimated audience size for each program:
Intended Publicity:

Fee Due to AHC:
No. of Discussion(s) x $50 =	$
Your Required Contribution: AHC asks that you estimate the value of the resources that you are putting into the project.
Staff and Volunteer Time	$
Services and Materials	$
Other	$
Fee Due to AHC (from above)	$
TOTAL CONTRIBUTION*	$
Payment will be due once your application is processed, and due at the same time as the signed contract.
* Required