2013 NMRT Professional Development Grant

First Name

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First and Last Name

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ALA Membership Number

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Are you an NMRT Member?

Yes
No

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Address

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City

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State

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Zip Code/Postal Code

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Country

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Phone Number

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Email Address

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Current Employer

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Job Title

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Supervisor's Name

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Supervisor's Job Title

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Supervisor's Phone Number

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Supervisor's Email Address

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Work Experience

Please keep your work experience to the last five years of employment.

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Honors, Awards, and Publications

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National Association Experience (ALA, NMRT, etc)

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Local Association Experience (State Associations, Local Chapters etc).

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Please tell us why you are most deserving of the NMRT Professional Development Grant. Please describe your long-term professional goals and what will you plan to contribute to ALA, NMRT, and the library profession.

Answers must be 500 words or less.

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In 500 words or less, please tell us how you plan to use your ALA Conference Experience at your home institution and local, state, and regional associations.

Answers must be 500 words or less.

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Reference #1

Provide the following information: Full name, title, address, phone number, and relationship to you (past supervisor, colleague, mentor, former co-worker, etc).

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Reference #2

Provide the following information: Full name, title, address, phone number, and relationship to you (past supervisor, colleague, mentor, former co-worker, etc).

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Reference #3

Provide the following information: Full name, title, address, phone number, and relationship to you (past supervisor, colleague, mentor, former co-worker, etc).

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How Did You Learn About This Award

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If you checked listserv or other in the question above, please provide more information about where you found out about this award.

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If chosen as the recipient of the NMRT Professional Development Grant, will you be able to attend ALA Annual in Chicago, IL from June 27-July 2, 2013.

The award will only cover expenses up to $1000. All other expenses will be paid by the award winner.

Yes
No

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If chosen as the recipient of the NMRT Professional Development Grant, can your employer provide their approval to accept the grant and to attend the 2013 ALA Annual in Chicago, IL?

Yes
No

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