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* 1. Library name:

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* 2. Library director

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* 3. How would you primarily characterize your library locale:

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* 4. What is the population of your library's service area?

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* 5. Please list any activities your library has conducted consistent with the Aspen Institute's vision framework.

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* 6. Please characterize the support of government officials and other civic leaders for your library. Would you say you have widespread support? Strong support from a few leaders? Please detail these relationships to the best of your ability.

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* 7. Please characterize potential community support for the dialogue and subsequent activities. Are there community or business leaders who are potentially supportive?

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* 8. Can your library contribute the following:

  Yes No Maybe
Local or state funding to advance an action agenda resulting from the dialogue
Sufficient staff to promote the dialogue and subsequent work
Sufficient staff to support the development and execution of the event

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* 9. Is there anything else you'd like us to know?

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* 10. As the library director or designee, I support the Aspen Institute's vision framework and will be committed to developing, planning, organizing, and implementing a Dialogue on Public Libraries in my library's service area.

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