North Carolina Library Association Project Grants Application Form

NORTH CAROLINA LIBRARY ASSOCIATION PROJECT GRANTS APPLICATION FORM

Submit to Carol Cramer

for Wanda Brown, Chair, NCLA Finance Committee

Z. Smith Reynolds Library, Wake Forest University, Box 7777 Reynolda Station, Winston-Salem, NC 27109

cramercj@wfu.edu

Project # ___________________

Voice: 363-758-3563

Fax: 363-758-5605

Name of Section, Round Table or NCLA Committee _____________________________________________________________________
Chair ____________________________________________	Phone ___________________
Person submitting application __________________________________________________
NCLA position or office ______________________________________________________
Address ________________________________________________
________________________________________________
Phone ___________________	Fax _______________________
Email _______________________________________

INFORMATION ABOUT THE PROPOSED PROJECT:

Title __________________________________________________________________

Dates (or projected completion date __________________________________________

Location _______________________________________________________________

Co-Sponsors ___________________________________________________________

    If program or workshop:

    Participants will be from (check all that apply)

    _____academic libraries _____special libraries _____school media centers

    _____public libraries _____learning resource centers _____other _______________

    If publication or special project:

    Target group (check all that apply)

    _____academic libraries _____special libraries _____school media centers

    _____public libraries _____learning resource centers _____other _______________

    Projected total number of participants or members of target group _______________
    (Use these estimates when completing final evaluation.)

If the grant is award,

I will submit an evaluation of the project to the NCLA Finance Committee Chair within two months of completion of the project;

I will submit all expenses with the appropriate Check Order Form to the NCLA Treasurer within two months of completion of the project; and,

I understand that failure to do so will make my NCLA Committee, Section or Round Table ineligible for future grants.

Signed: __________________________________________________ Date: ____________________

Signed: __________________________________________________ Date: ____________________

Signed: __________________________________________________ Date: ____________________