Professional Excellence Grant

Application

Name:

Address:

Name of Employing Library:

NOTE: Please submit a letter of employment and support from your supervisor
EX: Library Director, CountyCommission, or City Manager

Your Job Title:

Work Phone: ( ) e-mail:

I have been a Utah resident for over one year (required) ____Yes ____No

Title of course / workshop / conference:

Date(s) and location of course / workshop:

NOTE: You must submit a workshop/course agenda with this application form. Training must involve at least six contact hours.

Name of offering organization:

NOTE: If registering for a credit class in a library science degree program, enclose an unofficial transcript showing completion of at least six credit hours.

  1. Reason for attending (clarify reasons for selecting this event over others, impact on self, impact on library and patrons):

2.How will you use what you learn at this workshop in your library to benefit the end user, your patron?

3.You will be required to share what you learned with the larger Utah library community within one year. How do you plan to share what you’ve learned?

4.Recipients are required to acknowledge the Utah State Library and the State of Utah when undertaking and promoting grant supported activities. How will you acknowledge this contribution?

Financial details: Please provide projected total costs even though the grant maximum is $1,000. Be specific. The State Library pays for registrationortuition, lodging, and transportation expenses excluding car rental.

Proposed Budget Spreadsheet

Category

/

Amount

Requested from

UPLIFT Grant

/ Local or Other
Funds / Total
Funds
Operating Expenses
Registration/Tuition
Transportation*
Lodging*
Total Request
*These expenses will be paid according to UtahState per diem allowances
Mileage: equals 48.5 cents per mile and/or reasonable airfare at actual cost

All expenses are to be paid by self or sponsoring organization untilthe receipts (for credit courses, proof of registration, successful completion of the course with a grade of C or better) and the evaluation form are submitted the Utah State Library Division. USL will reimburse the grantee.

______

Signature of applicantDate

Checklist (State Library Division use):

  1. Application complete and signed (may send digitally) ______
  2. Letter of employment and support ______
  3. Workshop/course agenda enclosed ______
  4. Unofficial transcript (requiredfor MLS programrecipients)______

NOTE: UtahState Library Division must receive applications by 5 p.m. on the appropriate deadline (February 15, June 15, or October 15). The Division will send e-mail confirmation upon receipt of the grant application.

Send the completed application to:

Colleen Eggett, Training Coordinator

Utah State Library Division(801)715-6776
250 North 1950 West, Suite A(801)715-6767 fax

Salt Lake City,