First Name:
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Middle Name:
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Last Name:
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Street:
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Street:
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City:
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State:
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Zip:
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Phone:
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Email: (required)
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Library of Employment:
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Position title:
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Work unit:
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Work phone:
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Number of months employed:
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| Grant amount requested: ($); (Maximum $1,500) |
Title of course/workshop/conference to attend:
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Location of the event:
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| Name of institution offering the event: |
Web address of the event, if available: |
| Date of the event: to
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| Reasons for attending: [Clarify reason for selecting this event over
others, impact on self, library, statewide initiatives, etc] |
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| Anticipated benefits and outcomes on self, library, statewide initiatives,
etc. List other continuing education events/conferences/training attended in
the last 12 months. |
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| Financial Details |
| Provide projected total costs even if the event exceeds $1,500: |
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All the information above constitutes my application for the Carol McMurry Library Endowment Grant, and is true and correct to the best of my knowledge and belief. By submitting this form, I agree to abide by all Carol McMurry Library Grant requirements and indicate my understanding that all information will be furnished to the Selection Advisory Committee, and shall be confidential.
Date:
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