IMLS
PROGRAM INFORMATION SHEET
PLEASE NOTE: Information contained within this form may be made publicly available.
1. Applicant Information |
|||||||||||||||||||||||||||||
a. Legal Name as it appears in SAM.gov : (5a from SF424S): |
|
||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
b. Organizational D-U-N-S® Number (5f from SF-424S): |
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||
|
|||||||||||||||||||||||||||||
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 |
|
County |
|
||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||
State |
|
Zip+4/Postal Code |
|
|
|
|
|
- |
|
|
|
|
|||||||||||||||||
|
|
||||||||||||||||||||||||||||
f. Organizational Unit Type (check one): |
|||||||||||||||||||||||||||||
Academic Library |
Library Association |
School Library or School District applying on behalf of a School Library or Libraries |
|||||||||||||||||||||||||||
Aquarium |
Library Consortium |
||||||||||||||||||||||||||||
Arboretum/Botanical Garden |
Museum Library |
||||||||||||||||||||||||||||
Art Museum |
Museum Services Organization/Association |
Science/Technology Museum |
|||||||||||||||||||||||||||
Children’s/Youth Museum |
Special Library |
||||||||||||||||||||||||||||
Community College |
Native American Tribe/Alaska Native/Native Hawaiian Organization |
Specialized Museum** |
|||||||||||||||||||||||||||
Digital Library |
|||||||||||||||||||||||||||||
Four-year College |
Natural History/Anthropology Museum |
State Library |
|||||||||||||||||||||||||||
General Museum* |
State Museum Agency |
||||||||||||||||||||||||||||
Graduate School of Library and Information Science |
Nature Center |
State Museum Library |
|||||||||||||||||||||||||||
Planetarium |
Zoo |
||||||||||||||||||||||||||||
Historic House/Site |
Public Library |
Institution of higher education other than listed above |
|||||||||||||||||||||||||||
Historically Black College or University (HBCU) |
Research Library/Archives |
||||||||||||||||||||||||||||
History Museum |
|
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) |
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 |
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
||||||
* 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 |
|
IMLS PROGRAM INFORMATION SHEET
Refer to the Notice of Funding Opportunity for descriptions of these options and instructions for how to make selections.
3. Grant Program |
|
a. Laura Bush 21st Century Librarian Program |
d. Museums for America |
1. Select one: |
1. Select one: |
Planning Grant |
Learning Experiences
|
National Forum Grant |
Community Anchors |
Project Grant |
Collections Stewardship |
Research Grant |
|
2. Select one: |
2. Select one: |
Pre-professional |
$5,000–$25,000 with no cost share permitted. |
Masters-level and Doctoral-level Programs |
$25,001–$500,000 with cost share required. |
Early Career Development |
|
Continuing Education |
e. National Leadership Grants for Museums |
3. Select one: |
1. Select one: |
Advancing Digital Assets and Capacity Com Collections Stewardship |
|
Community Anchors |
Collections Care and Access |
National Digital Platform |
Diversity and Inclusion |
Curating Collections |
Professional Development |
|
2. Select one: Non-research grant, $50,000–$1,000,000 with cost share required. |
b. National Leadership Grants for Libraries |
|
1. Select one: |
Research grant, $50,000–$1,000,000 with no cost share required. |
Sparks Grant |
|
Planning Grant |
Rapid prototyping grant, $5,000–$50,000 with no cost share required. |
National Forum Grant |
|
Project Grant |
|
Research Grant |
f. Museum Grants for African American History and Culture |
2. Select one: |
|
Community Anchors |
|
National Digital Platform |
1. Select one: |
Curating Collections |
$5,000–$25,000 with no cost share permitted. |
|
$25,001–$150,000 with cost share required. |
c. Native American/Native Hawaiian Library Services |
|
g. Museums Empowered (an MFA Special Initiative) |
|
1. Select one: |
|
Native American Basic Grant |
|
Native American Enhancement Grant |
Digital Technology |
Native Hawaiian Library Services
|
Diversity and Inclusion |
|
Evaluation
|
|
Organizational Management |
|
|
|
$5,000 - $25,000 with no cost share permitted |
|
$25,001 - $250,000 with 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 |
|
|
|
|||
a. IMLS funds requested: |
|
b. Cost share amount: |
|
|
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) |
People with Mental or Physical Challenges/Disabilities |
|||||||||||||||||
Adolescents/High School (13-19 years) |
People Who Are Low Income/Economically Disadvantaged |
|||||||||||||||||
Adults |
Rural Populations |
|||||||||||||||||
Aging, Elderly, Senior Citizens (65+ years) |
Scholars/Researchers |
|||||||||||||||||
Ethnic or Racial Minority Populations other than Native Americans/Native Hawaiians |
Unemployed |
|||||||||||||||||
Urban Populations |
||||||||||||||||||
Families/Intergenerational |
Other |
|||||||||||||||||
Immigrants/Refugees |
|
|||||||||||||||||
Military Families |
||||||||||||||||||
If other, please specify: |
|
|||||||||||||||||
|
||||||||||||||||||
7. Museum Profile (Museum Applicants Only) |
||||||||||||||||||
a. Is your institution organized on a permanent basis for essentially educational or aesthetic purposes, and is it 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. |
Yes |
No |
||||||||||||||||
b. Does your institution own or use tangible objects, either animate or inanimate? |
Yes |
No |
||||||||||||||||
c. Does your institution care for these objects? |
Yes |
No |
||||||||||||||||
d. Does your institution exhibit these objects to the general public at least 120 days a year through facilities your institution owns or operates? |
Yes |
No |
||||||||||||||||
e. Your institution’s attendance for the 12-month period prior to the application |
||||||||||||||||||
|
|
|
|
|
||||||||||||||
|
||||||||||||||||||
f. Year your institution was first open and exhibiting to the public: |
|
|
|
|
|
|||||||||||||
|
||||||||||||||||||
g. Total number of days your institution was open to the public for the 12-month period prior to application: |
|
|
|
|
||||||||||||||
h. Does your 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 your institution? |
Yes |
No |
||||||||||||||||
i. Number of full-time paid institution staff: |
|
|
|
|
|
|||||||||||||
|
||||||||||||||||||
j. Number of full-time unpaid institution staff: |
|
|
|
|
|
|||||||||||||
|
||||||||||||||||||
k. Number of part-time paid institution staff: |
|
|
|
|
|
|||||||||||||
|
||||||||||||||||||
l. Number of part-time unpaid institution staff: |
|
|
|
|
|
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). |
||||
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 |
Interpretation |
|||
Digital Media |
K-12 Programs, With Schools |
|||
Early Learning |
K-12 Programs, Out of School |
|||
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 Research and Evaluation |
Community Outreach |
|||
Civic Engagement |
Digital Media |
|||
Community-Driven Exhibitions and Programs |
Professional Development/Training |
|||
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): |
||||
Access and Use |
Collections Management |
Conservation |
||
Database Management |
Cataloguing, Inventorying, Registration |
Conservation Environmental Improvement/Rehousing |
||
Digitization |
Collections Information Management |
Conservation Survey |
||
Software Applications |
|
Conservation Treatment |
||
Website Development |
Collections Planning |
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: 7/31/2018 IMLS-CLR-F-0028 |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Jessica Meade |
File Modified | 0000-00-00 |
File Created | 2021-01-14 |