RASS Continuing Education Grant Application Form


Name:____________________________________________Date:_______________

 

Home Address:____________________________________________________________

 

Home Phone: (______)_______________________________________________

 

E-mail:_____________________________________________________________

 

Employer:_____________________________________________________________

 

Employer's Address:_______________________________________________________

 

Employer's Phone: (_______)_________________________________________

 

Job Title:________________________________________________________________

Brief Description of Current Position:

 

 

Preferred Mailing Address (check one) Employer:_____ Home:_________

 

NYLA Membership Number__________________

 

RASS Member? Yes:______ No:______

 

Title of Course/Workshop/Continuing Education Program:

 

_________________________________________________________________________

 

Sponsoring Organization/Institution:________________________________________________

 

Description of Course/Workshop/Program:



Location of Program:_________________________________________________

 

Date(s) of Program:___________________________________________________

 

Tuition:______________________ Projected Costs:_________________

 

Amount of Support Requested from RASS:_________________________

 

How will this continuing education activity enhance your ability to provide library information to adults?
(Attach your typed, double-spaced reply, limited to 250 words or less)

 

Signature of Applicant_____________________________________Date_______________

 

Please email or fax completed application form to the RASS Awards Chair:

Margaret J. Gibson
Assistant Community Library Manager/YA Librarian
East Elmhurst Community Library
95-06 Astoria Blvd
East Elmhurst, NY 11369
(718) 424-2619
mgibson@queenslibrary.org