Program Information Sheet 1

FY18 PIS Final 2017-06-21.docx

Generic Clearance for IMLS Grant Forms: Budget Form, Program Information Sheet, and Digital Product Form, EGMS PIS Supplementary Sheet, eGMS Abstract form

Program Information Sheet 1

OMB: 3137-0092

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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

  1. Select one:

Native American Enhancement Grant

Digital Technology

Native Hawaiian Library Services


Diversity and Inclusion


Evaluation



Organizational Management


  1. Select one:


$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



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OMB Number 3137-0071, Expiration date: 7/31/2018 IMLS-CLR-F-0028


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