Please complete the following application and return it to the NNY Library Network by hitting the "Submit" key at the end of the form.

Name:
Employer:
Position/Title:
Work Address:
Work Telephone:
Home Address:
Home Telephone:

I. Please name and describe the continuing education activity in which you wish to participate. (Attach event or course URL, if available).

A. Title:
B. Date(s):
C. Place:
D. Sponsoring Organization:
E. Event/Course URL:

II. Provide a narrative in the space provided below explaining why you wish to attend this activity. Please address: the relevance of this activity to your current responsibilities and/or future professional plans, and indicate whether you are applying for the entire cost of this activity or whether the cost will be shared from other sources. If the cost will be shared, please indicate the source of the other funds.

III. Budget

Please provide a breakdown by category of the funds requested.

A. Registration or tuition funds:

B. Travel expenses

1. Automobile Miles at $0.50

2. Plane/Train/Bus

3.Other (Specify)

C. Lodging

D. Meals (Per diem rate is $39/day for meals.)

TOTAL REQUESTED (Maximum $1,000)

NOTE: ALL awards will be made on a reimbursement basis upon presentation of receipts.

(Updated 2010)