Program Information Form

For Office Use Only ___________________________

IMLS PROGRAM INFORMATION SHEET
PLEASE NOTE: Information contained within this form may be made publicly available.
1. Applicant Information
a. Legal Name (5a from SF424S):
b. Organizational D-U-N-S® Number (5f from
SF424S):
c. Expiration date of your SAM.gov registration

d. Organizational Unit Name (if different from Legal
Name):
e. Organizational Unit Address (if different from Legal Name address)
Street 1
Street 2
City
State

County

Please Select Your State

Zip+4/Postal Code

-

f. Organizational Unit Type (check one):
Academic Library

Library Association

Aquarium

Library Consortium

Arboretum/Botanical Garden

Museum Library

Art Museum

Museum Services
Organization/Association

Children’s/Youth Museum
Community College
Digital Library
Four-year College
General Museum*
Graduate School of Library and
Information Science
Historic House/Site
Historically Black College or
University (HBCU)
History Museum

Native American Tribe/Alaska
Native/Native Hawaiian
Organization

School Library or School District
applying on behalf of a School
Library or Libraries
Science/Technology Museum
Special Library
Specialized Museum**

Natural History/Anthropology
Museum

State Library

Nature Center

State Museum Library

Planetarium

Zoo

Public Library
Research Library/Archives

State Museum Agency

Institution of higher education
other than listed above
Other

* A museum with collections representing two or more disciplines equally (e.g., art and history)
** A museum with collections limited to one narrowly defined discipline (e.g., textiles, maritime, ethnic group)

OMB Number 3137‐0071, Expiration date: 07/31/2018

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IMLS PROGRAM INFORMATION SHEET
2. Organizational Financial Information
a. Please complete the following table for the Organizational Unit for the three most recently completed fiscal years.
Fiscal Year

Total Revenue*

Total Expenses**

Surplus or Deficit

$0

* For nonprofit tax filers, Total Revenue can be found on Line 12 of the IRS Form 990.
** For nonprofit tax filers, Total Expenses can be found on Line 18 of the IRS Form 990.
b. If you had a budget surplus or deficit greater than 10% of your annual operating budget for two or more of the three
fiscal years listed above, please explain the circumstances of this surplus or deficit in the box below.

c. Were there any material weaknesses identified in your prior year’s audit report?
Yes
No
Not applicable
A material weakness is a deficiency, or combination of deficiencies, in internal control, such that there is a reasonable
possibility that a material misstatement of the entity’s financial statements will not be prevented, or detected and
corrected on a timely basis.

If yes, please explain.

d. Has your organization had an A-133 audit in the past three years?
Yes

No

OMB Number 3137‐0071, Expiration date: 07/31/2018

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IMLS PROGRAM INFORMATION SHEET
3. Grant Program Information
a. Laura Bush 21st Century Librarian Program
Select one funding category:
Project Grant
Planning Grant
National Forum Grant
Research Grant
Select one project category:
Masters-level and Doctoral-level Programs
Research and Early Career Development
Continuing Education and Programs to Build
Institutional Capacity

b. National Leadership Grants for Libraries
Select one funding category:
Project Grant
Planning Grant
National Forum Grant
Research Grant

c. Native American/Native Hawaiian Library
Services

d. Sparks! Ignition Grants
Select one:
■
Museum
Library
e. Museums for America
Select one project category:
Learning Experiences
Community Anchors
Collections Stewardship
Select one funding level:
IMLS funds requested total $25,000 or less with no
applicant cost share permitted.
IMLS funds requested total more than $25,000 with
applicant cost share required.

f. National Leadership Grants for Museums
Select one project category:
Learning Experiences
Community Anchors
Collections Stewardship

g. Museum Grants for African American History and
Culture

Select one funding level:
Select one funding category:
Basic Grant Only
Basic Grant with Education/Assessment Option
Enhancement Grant
Native American Library Services

IMLS funds requested total $25,000 or less with no
applicant cost share permitted.
IMLS funds requested total more than $25,000 with
applicant cost share required
h. Native American/Native Hawaiian Museum
Services

4. Performance Goals
Select one of the following three IMLS agency-level goals: (a) Learning, (b) Community, or (c) Content and Collections. Then
select at least one of the performance goals listed beneath it:
a. Learning
Train and develop museum and library professionals
Support communities of practice
Develop and provide inclusive and accessible learning opportunities
b. Community
Strengthen museums and libraries as essential partners in addressing the needs of their communities
c. Content and Collections
Broaden access and expand use of the Nation’s content and collections
Improve management of the Nation’s content and collections
Improve preservation, conservation, and care of the Nation’s content and collections
If you select a performance goal listed beneath Learning or Community for your project, click here to review the specific
performance measure statement choices and the information you will be required to collect for each.
5. Funding Request Information
a. IMLS funds requested:
OMB Number 3137‐0071, Expiration date: 07/31/2018

b. Cost share amount:
IMLS-CLR-F-0028

OMB Number 3137‐0071, Expiration date: 07/31/2018

IMLS PROGRAM INFORMATION SHEET
6. Population Served
Please select the target population(s) served by the proposed project:
General Population

Museum and/or Library Professionals

Early Childhood/Preschool (0-5 years)

Native Americans/Alaska Natives/Native Hawaiians

Middle Childhood/Primary School (6-12 years)

Adults

People with Mental or Physical Challenges/Disabilities
People Who Are Low Income/Economically
Disadvantaged
Rural Populations

Aging, Elderly, Senior Citizens (65+ years)

Scholars/Researchers

Ethnic or Racial Minority Populations other than
Native Americans/Native Hawaiians

Unemployed

Families/Intergenerational

Other

Adolescents/High School (13-19 years)

Urban Populations

Immigrants/Refugees
Military Families
If other, please specify:
7. Museum Profile (Museum Applicants Only)
a. Is your institution either a private not-for-profit organization that has tax-exempt status under
the Internal Revenue Code or a unit of state or local government that is organized on a
permanent basis for essentially educational or aesthetic purposes?

Yes

No

b. Is your institution open and exhibiting tangible objects to the general public at least 120 days
a year through facilities your institution owns or operates?

Yes

No

c. Does your institution own or use these objects, whether animate or inanimate?

Yes

No

d. Does your institution care for these objects?

Yes

No

e. Does your institution exhibit these objects to the general public on a regular basis through
facilities your institution owns or operates?

Yes

No

f. Institution’s attendance for the 12-month period prior to the application
On-site:

Off-site:

g. Year the institution was first open and exhibiting to the
public:
h. Total number of days the institution was open to the public for the 12-month period prior to
application:
i. Does the institution employ at least one professional staff member, or the full-time equivalent,
whether paid or unpaid, who is primarily engaged in the acquisition, care, or exhibition to the
public of tangible objects owned or used by the institution?

Yes

No

j. Number of full-time paid institution staff:
k. Number of full-time unpaid institution staff:
l. Number of part-time paid institution staff:
m. Number of part-time unpaid institution staff:

OMB Number 3137‐0071, Expiration date: 07/31/2018

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IMLS PROGRAM INFORMATION SHEET
8. Project Elements (Museums for America and National Leadership Grants for Museums Applicants Only)
Your response to this question will help us match your application to reviewers with appropriate experience. Make your
choice under the project category that you selected in Question 3 (Grant Program Information).
LEARNING EXPERIENCES
If you are applying in the Learning Experiences Project Category, select the primary element that is core to your
proposed project from the list below (check only one):
Adult Programs/Lifelong Learning

Interpretation

Digital Media

K-12 Programs, with Schools

Early Learning

K-12 Programs, out of Schools

Exhibitions

Professional Development/Training

Family Programs

Public Programs

COMMUNITY ANCHORS
If you are applying in the Community Anchors Project Category, select the primary element that is core to your
proposed project from the list below (check only one):
Audience Development/Community Outreach

Digital Media

Audience Research and Evaluation

Professional Development/Training

Civic Engagement

Visitor Experience

Community-Driven Exhibitions and Programs
Community-Focused Planning Activities

COLLECTIONS STEWARDSHIP
If you are applying in the Collections Stewardship Project Category, select the primary element that is core to your
proposed project from the list below (check only one):
Conservation

Collections Management

Environmental Improvement/Rehousing

Cataloguing, Inventorying, Registration

Survey

Collections Planning

Treatment

Information Management
Professional Development/Training

Please identify the material type(s) that will be affected by your project:
Animals, living

Photographic Materials

Animals, preserved

Plants, living

Architecture

Plants, preserved

Books and Paper

Sculpture

Electronic Media

Textiles

Objects

Wooden Artifacts

Paintings

OMB Number 3137‐0071, Expiration date: 07/31/2018

IMLS-CLR-F-0028