Express Hospital Library Promotion Award Application
1. Name of Network Member Institution:
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2. Network Member LIBID:
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3. Network Member Name:
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4. Position/Title of Project Manager:
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5. Department:
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6. Mailing Address:
Street 1:
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Street 2:
City:
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State:
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Zip Code:
(e.g., 99999 or 99999-9999)
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7. Email Address (e.g., maryc@project.org):
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8. Telephone Number [e.g., (222) 222-2222 or 555-555-5555]:
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9. Fax Number [e.g., (222) 222-2222 or 555-555-5555]:
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10. Award funding is a maximum of $5,000.00 please supply a brief budget.
- Funding will cover personnel, communication, equipment, supplies, reproduction, and travel.
- No additional food costs are allowed.
- No indirect costs are allowed.
11. How will you spend the award? (Provide a cost break down and justification for each budget line.)
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12. Award should be made payable to what institution (i.e., Southeastern Regional Medical Center)?
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13. Federal Tax Id Number (FEIN):
*
*
*
16. Proposed start date for project ending April 30, 2013 (e.g. 10/19/2011):
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17. Project Title:
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18. Provide a summary statement of the proposed project or study:
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19. Describe the institutional environment and current role/status of the library and library staff:
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20. Identify the project objectives and desired outcomes:
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21. How will you measure your outcomes?
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22. List any institutional support that will be provided.
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23. With which individuals or departments will you work? In what ways will they participate?
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24. How will you promote/publicize the project and report your findings?
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25. Comments
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