<p> LSTA FY2018 DIRECT GRANT PROGRAM LETTER OF INTENT FORM DUE TO MBLC: FRIDAY, DECEMBER 9, 2016</p><p>Contact Person's Name & Title: ______</p><p>Library/Agency/System/Institution: ______</p><p>Address: ______Municipality/Zip: ______</p><p>Phone and e-mail:______</p><p>Library Director’s Signature:______</p><p>1. ELIGIBILITY:</p><p>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. </p><p>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</p><p>2. TYPE: The above-listed applicant intends to submit an LSTA application under the following program: (CHECK ONLY ONE)</p><p>☐ 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</p><p>3. ESTIMATED AMOUNT REQUESTED: $______</p><p>Please email form to: Amy Clayton, Administrative Coordinator, [email protected] </p><p>DEADLINE: FRIDAY, DECEMBER 9, 2016</p>