ICfL Continuing Education Grant Evaluation and Request for Reimbursement Form

Select the type of CE Grant which you received from ICfL: *

1st Time Conference Attendance Grant Library Science Course Grant Group Training Grant Leadership Development Activity Grant

After this Library Science Course 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.

CE Grant Number:

Library Name:

Library Director's E-mail Address: (a copy of this completed form will be emailed to this address)

CE event participant name:

First Name Last Name

Participant's E-mail Address:

Electronic copies of this reimbursement request form will automatically be sent to the two email addresses listed on this form once submitted.

Name of Conference/ Course/ or Training on which you are reporting: *

Example: Conference title, course name

SPECIAL NOTE FOR GROUP 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 funder, the Institute of Museum and Library Services. Thank you for your assistance.

I learned something by participating in this library activity: *

Strong Agree Agree Neither Agree or Disagree Disagree Strongly Disagree

I am confident about using what I have learned: *

Strong Agree Agree Neither Agree or Disagree Disagree Strongly Disagree

I am likely to apply what I have learned: *

Strong Agree Agree Neither Agree or Disagree Disagree Strongly Disagree

Applying the resource/what I have learned will help improve library services to the public: *

Strong Agree Agree Neither Agree or Disagree Disagree Strongly Disagree

Complete parts A-C of the LSTA Request for Reimbursement form below: *

Enter Dollar Amount

A. Grant Award Amount (this includes any Indirect Cost that you chose to apply)

B. Reimbursement Request Amount (this amount cannot exceed section A amount)

C. Balance of Remaining Grants Funds, if any

Please complete the LSTA Financial Report that was sent to you as part of your grant award documentation (this was attached to the initial email sent to you announcing your grant approval). This customized financial report details the aniticipated CE event expenses (Section 1 of form) for which you were approved during the application process. Now it is time to complete your actual CE event expenses (Section 2 of the form). Be prepared to scan and upload copies of your receipts for all expenses listed in the Grant side of the form - Section 2-A. 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 attached and uploaded to this form. Please contact ICfL's Grants Officer with financial questions at (208) 334-2150.

Attach completed LSTA Financial Report: *

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

Attach copies of your Grant Expenses listed in Section 2-A of the Financial Report form (not Local Match expenses): *

Certification Statement: I hereby request the above reimbursement and certify that this claim is true, correct and in accordance with the terms of the grant agreement.

As the CE event participant, please enter your name to certify: *

ICfL Continuing Education Grant Evaluation & Request for Reimbursement Form

Part I: Narrative Reporting

Part II: Financial Reporting