ICfL Continuing Education Grant Evaluation and Request for Reimbursement Form

ICfL Continuing Education Grant Evaluation & Request for Reimbursement Form
Grant Award Number:*
Library Name:*
Library Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Library Director's Email Address (a copy of this form will automatically be emailed to this address):*
CE event Participant Name:*

First NameLast Name
Participant's Email Address:*
Electronic copies of this reimbursement request form will automatically be sent to the two email addresses listed on this form once submitted.
Part I: Narrative Reporting

This grant is brought to you in part by the Institute of Museum and Library Services (IMLS). Please try to mention them in your narrative report.
Select the type of CE activity you participated in as part of your CE Grant:*

1st Time Conference AttendanceLibrary Science CourseGroup TrainingLeadership Development Activity
If you attended a library science course, what will be your educational status after you complete this grant?:

I have completed my MLS.I have completed my Teacher/Librarian Certification.I will be continuing to pursue my MLS or Teacher/Librarian Certification in the immediate future.I will not be pursuing further professional coursework at this time.
Name of conference or course you attended:*
Example: Conference title, course name
Dates you participated in CE event/course:*
SPECIAL NOTE FOR GROUP TRAINING GRANTS: If you are reporting on a Group Training Grant, please gather brief responses from EACH participant in the training prior to completing this report. Once you have all the responses, please consolidate these responses and enter them into the response boxes below.
Did your participation in this CE event meet the expectations identified in your application? If so, how? If not, can you identify why?*

0/500
Describe how, in the next 3-5 months, you will apply or implement what you have learned from this event in your library.*

0/500
Provide examples of how you will share this information with your library community and/or your end users. *

0/500
Complete the following sentence: "My library users will benefit from the enhanced programs/activities/ services gained through this conference because they will be able to...":*

0/200
The following questions are required by our federal partner, the Institute of Museum and Library Services. Thank you for your assistance.
I learned something by participating in this library activity:*

Strong AgreeAgreeNeither Agree or DisagreeDisagreeStrongly Disagree
I am confident about using what I have learned:*

Strong AgreeAgreeNeither Agree or DisagreeDisagreeStrongly Disagree
I am likely to apply what I have learned:*

Strong AgreeAgreeNeither Agree or DisagreeDisagreeStrongly Disagree
Applying the resource/what I have learned will help improve library services to the public:*

Strong AgreeAgreeNeither Agree or DisagreeDisagreeStrongly Disagree
Part II: Financial Reporting
Original Grant Award Amount:*
This is the award amount listed in your grant application/agreement.

Itemized Expenses:*

	Estimated Expenses listed in Original Application	Actual Expenses to be Paid by Grant Reimbursement (cannot exceed original award amount)	Actual Expenses Paid by Library/Individual (Local Match)
Conference Registration
Lodging
Airfare
Baggage Fee
Airport Shuttle/Parking
Mileage ($0.65/mile)
Ground Transportation
Meals (match only)
Pre-Conference Fees (match only)
Library Science Course Tuition
Library Science Course Materials
Speaker Fees
Other

Requested Reimbursement Amount from Grant Award (automatically calculated from table above). This is the reimbursement you are requesting to cover the actual expenses listed above. This amount cannot exceed the initial grant award amount. A check for this amount will be mailed to your library at the address you provide in this form.:
Local Match (automatically calculated from table above). This must equal at least 25% of the total expenses. First-Time Conference Grants do not have a matching funds requirement.:
Total expenses paid for by grant and local match (automatically calculated from table above):
Please scan and upload copies of your receipts for all actual expenses listed. Event expenses which do not fall under the Grant side will be claimed under the Local Match side of the form - copies of the match expense receipts do not need to be uploaded. Please contact ICfL's Grants/Contracts Officer with financial questions at libgrants@libraries.idaho.gov.
Attach copies of your Grant Expenses listed in the table above. You do not need to include receipts for local match expenses.*

Upload a File

Cancelof
If this is a Library Science Course grant, please attach a copy of your course grade:

Upload a File

Cancelof
Electronic Signature. Please type your name in the field below to certify that the reimbursement request you are submitting is true, correct, and adheres to the terms of your grant agreement.*
The ICfL will process this reimbursement request within one to two weeks. A check will then be mailed from the State of Idaho vendor system to the library at the address you provided. If your library's mailing address is different from the address you provided please email us at libgrants@libraries.idaho.gov. If your library has not recieved a grant from the ICfL recently, please email a W-9 form for the library to the same email address.
Disbursement Form - ICfL Staff Use Only
Continuing Education (CE) Grants FY 25
Check Amount:
Project Title: CE Grants - Federal (T&B)

Project Number: 521210480

Org: 1000

Appropriation Unit: EDLA

Fund: 34800

Account Code: 864500 - Misc Unit Govt Federal Subgrt

Funding Source: 521LSTA23
Date Disbursement Form Signed:
Make Check Payable to:
Grants/Contracts Officer Signature:

Clear
Should be Empty:

ICfL Continuing Education Grant Evaluation & Request for Reimbursement Form

Part I: Narrative Reporting

Part II: Financial Reporting

Disbursement Form - ICfL Staff Use Only