Mike Jaugstetter Memorial Leadership Grant Application
Grant Applicant
Name
*
First Name
Last Name
Organization
*
Primary Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you a current member of NDLA?
*
Yes
No
Have you been a member for the past two years (24 months)?
*
Yes
No
Have you received an NDLA grant within the past 24 months?
*
Yes
No
Do you reside in North Dakota?
*
Yes
No
Are you currently employed in a North Dakota library?
*
Yes
No
Host Organization
Organization for which you are applying to attend an event, training, etc.
Host Organization
*
Contact Name
*
First Name
Last Name
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email
*
example@example.com
Contact Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Application Materials
Are you willing to participate in the NDLA Executive Board for one year? Note: Participation may include (but not be limited to) section chair, officer, committee chair, or committee work appointed by the President of NDLA.
*
Yes
No
Are you willing to present a leadership program at the annual NDLA Conference that follows your participation in the leadership program or institute?
*
Yes
No
Are you willing to participate in the committee selection of the following year's recipient?
*
Yes
No
Are you willing to submit an evaluative report to NDLA upon program completion for publication in The Good Stuff? Note: grant money will be awarded after the report has been received by the NDLA President. A copy of CEU certificate or letter of recognition should accompany the report, if applicable.
*
Yes
No
Attach your resume or CV
*
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Attach documentation describing the program
*
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Attach detailed budget of actual expenses
*
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Describe your professional growth or career development expectations from the proposed program (between 200-250 words).
*
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