Form Application Form 6 Application Form 6 Grant Reviewer Application Form: Library Reviewer

For Library Professionals

Please fill out the contact information and experience portion below. 
Contact/Experience Information 

Title: 

First Name: 

Middle Name: 

Last Name: 

Institution: 

Job Title: 

Mailing Address: 

City: 

State: 

Zip: 

‐

Shipping Address: 

City: 

State: 

Zip: 

‐

Work Phone: 

Home Phone: 

OMB No. [___________] Exp. [______] 

‐ 

‐

‐

E‐mail: 

Fax: 

Highest Academic 
Degree: 

Field of Study: 

Years of teaching experience in library/information science: 

Years of professional experience in library/information science: 

Types of experience in the past five years: (Please check all that apply)

Curriculum Development  
Archives and Special Collections  
Description  
Digitization  
Distance Education  
Information Literacy  
Intellectual Property  
Library Administration  
Library/Information Science Education ‐ Doctoral Level  
Library/Information Science Education ‐ Master's Level  
Metadata  
Pre‐professional Education  

OMB No. [___________] Exp. [______] 

Preservation  
Public Services  
Reference  
Research  
School Library/Media  
Service to Underserved Populations  
Student Recruitment/Retention  
Technology/Automation  
Web Design  
Other, such as work with networks & database design (please describe) 

Please provide any additional information you would like about your expertise and interest in being an 
IMLS reviewer. 

 Demographic Information (optional)
Gender:

Male

Race (check all that apply)::
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Do not wish to provide

OMB No. [___________] Exp. [______] 

Ethnicity:

Hispanic or Latino

Resume:  
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If you have any questions, please call the IMLS Office of Library Services at (202) 653-4700.
TTY for hearing impaired: (202) 653-IMLS (4657). Or email us at [email protected].

IMLS is collecting this information in conformance with the Museum and Library Services Act of 2010, as amended, and the
Privacy Act of 1974. IMLS may use the information collected for statistical purposes and in connection with the design,
implementation, and monitoring of IMLS efforts to increase the participation of various groups in the IMLS peer review
process. The information collected will be kept confidential to the extent permitted by law.

OMB No. [___________] Exp. [______]