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4. Thank you for your interest in offering a new recreational opportunity to our community! Ephraim city strives to have the best programs possible for every age group and ability. As such we look to create partnerships with anyone who wants to provide a new and helpful opportunity to Ephraim residents.

   Please complete this Program Proposal Form and submit it to Recreation staff for evaluation and review. This form does not constitute a contract or qualify for application for employment. Ephraim city does not discriminate against race, gender, gender identity, ability, age, birthplace, income, cultural background, religion, or ideology.

6. First Name
7. Last Name
9. Phone Number
11. Email Address
13. Address
15. City
16. State
17. Zip Code
19. Name of Program
21. Email Address
22. Phone Number
24. Bio

    (please provide two or three sentences about yourself)

26. Certifications

    (please provide any certifications that you hold pertaining to this program submission)

28. Name of Program
30. Explain the new program idea you have
32. Purpose of Program
34. Please list Instructor(s)
36. Frequency of Program
37. Proposed Start Date
38. Proposed End Date
39. Proposed Start Time
41. Proposed End Time
42. Are your times and dates flexible?
44. Available Days of the Week

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
45. Available Times of the Week

    1. Morning (8-12 PM)
    2. Afternoon (12-4 PM)
    3. Evening (4-10 PM)
47. Location
49. Proposed Program Fee Per Person
51. Is this event intended for a specific demographic?

    (For example: age group, school level, gender, ethnicity, etc.)

53. Minimum Age for Program
54. Maximum Age for Program
56. Do you believe Ephraim has the demographic you are looking to reach? Please explain
58. Please list the supplies you will provide for the program:
60. Please list the supplies that participants are encouraged to bring for the program:
62. Please list special site or set-up requirements needed for the program:
64. Any other details you would like to add:
66. Will you need any assistance during or before the program due to accessibility?

68. If you have any questions or concerns about this application, please contact Brandon at brandon.lefevre@ephraimcity.org.

Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit Submit and Print

* indicates a required field