FY2018 LSTA Letter of Intent Form

LSTA FY2018 DIRECT GRANT PROGRAM LETTER OF INTENT FORM DUE TO MBLC: FRIDAY, DECEMBER 9, 2016

Contact Person's Name & Title: ______

Library/Agency/System/Institution: ______

Address: ______Municipality/Zip: ______

Phone and e-mail:______

Library Director’s Signature:______

1. ELIGIBILITY:

A. Do you have a current Long Range Plan on file at the MBLC? Yes  No  B. Have you completed a FY2018 Action Plan? Yes  No  C. Are you a member of the Massachusetts Library System? Yes  No  D. If you are a public library, your municipality is certified in the Yes  No  N/A  FY2016 State Aid Program.

If you have any questions about your eligibility in this grant round please contact Amy Clayton at the MBLC by email at [email protected] or phone at 1-800-925-7403 or 617-725-1860 ext. 228

2. TYPE: The above-listed applicant intends to submit an LSTA application under the following program: (CHECK ONLY ONE)

☐ Citizenship Corners & Expanded English ☐ Full STEAM Ahead ☐ Preservation Assessment Language Services for New Americans ☐ Conserving & Digitizing Historical ☐ Preservation/Conservation of ☐ Innovative “Open” Project Resources Library & Archival Materials ☐ Jobs/Career Information ☐ Customer Experience ☐ Science is Everywhere for Your Library ☐ Manuscripts Arrangement ☐ Serving People with ☐ Financial Literacy for All Ages & Description Disabilities ☐ Framework for Health Literacy ☐ Mind in the Making ☐ Serving Tweens & Teens

3. ESTIMATED AMOUNT REQUESTED: $______

Please email form to: Amy Clayton, Administrative Coordinator, [email protected]

DEADLINE: FRIDAY, DECEMBER 9, 2016