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Training Award Application

1. Name of Network Member Institution:
*

2. Network Member LIBID:
*

3. Proposed Trainer:
*

4. Position/Title of Proposed Trainer:
*

5. Mailing Address:
Street 1:  *
Street 2: 
City:  *
State:  *
Zip Code:  (e.g., 99999 or 99999-9999) *

6. Email Address (e.g., maryc@project.org):
*

7. Telephone Number [e.g., (222) 222-2222 or 555-555-5555]:
*

8. Fax Number [e.g., (222) 222-2222 or 555-555-5555]:
*

9. Award funding is $1,000.00 please supply a brief budget.
Funding will cover costs for travel (per diems, hotel, transport, etc) reproduction, communication and equipment or room rental, if needed.
No course development or indirect costs are allowed for this award.

Expenditure Category Total Charges
Personnel
Equipment
Supplies
Travel
Reproduction
Communication
Other (specify)
Total Amount Requested ($1,000 maximum): $0

10. How will you spend the award? Provide a cost break down and justification for each budget line.
4,000 characters left

11. Award should be made payable to what institution (i.e., Southeastern Regional Medical Center)?
*

12. Federal Tax Id Number (FEIN):
*

*

*

15. Describe target population or audience for training.
4,000 characters left

16. Outline of training, number and location of session.
4,000 characters left

17. Plans for evaluation of training, instruction.
4,000 characters left

18. Plans for follow-up with trainees and/or partner organizations(s).

4,000 characters left
19. Comments
4,000 characters left

 the form then submit to the SE/A office for review

Contact us at:

NN/LM SE/A Region

University of Maryland, Baltimore

Health Sciences and Human Services Library

601 W. Lombard Street

Baltimore, MD 21201-1512

Phone: 1-800-338-7657 or 410-706-2855

Last updated on Tuesday, 03 May, 2011

Funded by the National Library of Medicine under contract HHS-N-276-2011-00004-C with the Health Sciences and Human Services Library of the University of Maryland