2019 National Medal Form

National Medals PRA Clearance [YEAR-MONTH-DAY]

2019 Nomination Form

National Medal for Museum and Library Service

(To be filled out by the nominated organization.)

A. Cover Sheet

1. Legal Name of your Organization:¹ _________________________________________________________________

Organizational Unit (if different from Legal Name): ____________________________________________________

2. Organization Address

Street 1: ____________________________ Street 2: ______________________________________

City: _______________________________ County: _______________________________________

State: ______________________________ Zip+4/Postal Code: ______________________________

3. Telephone Number: ___________________ 4. Fax Number: ___________________________________

5. Web Address: http://_____________________________________________________________________________

5. Name of Organization’s Director/CEO: _______________________________________________________________

Title: __________________________________________________________________________________________

E-mail: ______________________________ Telephone Number: ______________________________

5. Your Name (the person completing this form): _________________________________________________________

Title: ___________________________________________________________________________________________

E-mail: ______________________________ Telephone Number: _______________________________

5. Type of Organization (check one):

□ Academic Library □ Natural History/Anthropology Museum

□ Aquarium □ Nature Center

□ Arboretum/Botanical Garden □ Planetarium

□ Art Museum □ Public Library

□ Children’s/Youth Museum □ Research Library/Archives

□ Digital Library □ School Library, or School District applying on

□ General Museum² behalf of a School Library or Libraries

□ Historic House/Site □ Science/Technology Museum

□ History Museum □ Special Library

□ Library Association □ Specialized Museum³

□ Library Consortium □ Zoo

□ Museum Library □ Other, please specify: ______________________________

A. Cover Sheet (continued)

5. Governing Control (check one):

□ State Government □ Nonprofit with 501(c)3 IRS Status (Other than Institution

□ County Government of Higher Education)

□ City or Township Government □ Nonprofit without 501(c)3 IRS Status (Other than Institution

□ Special District Government of Higher Education)

□ Regional Organization □ Private Institution of Higher Education

□ U.S. Territory or Possession □ Individual

□ Independent School District □ For-Profit Organization (Other than Small Business)

□ Public/State-Controlled Institution of □ Small Business

Higher Education □ Hispanic Serving Institution

□ Indian/Native American Tribal □ Historically Black Colleges and Universities (HBCUs)

Government (Federally Recognized) □ Tribally Controlled Colleges and Universities (TCCUs)

□ Indian/Native American Tribal □ Alaska Native and Native Hawaiian Serving Institutions

Government (Other than Federally □ Nondomestic (non-U.S.) Entity

Recognized) □ Other, please specify: ______________________________

□ Public/Indian Housing Authority

5. Nominated Organization’s D-U-N-S® Number:⁴ ________________________________________________

5. Nominated Organization’s Employer/Taxpayer Number (EIN/TIN): ________________________________

5. Congressional District of Nominated Organization:⁵ ____________________________________________

5. Organization’s Annual Operating Budget: ____________________________________________________

Fiscal Year	List Total Revenue/ Support Income6	List Total Expense/ Outlays7	Difference between B. Total Revenue and C. Total Expenses
Most recently completed FY ___ (insert)
Second most recently completed FY ___ (insert)

15. If your organization had a deficit greater than 10% of your annual operating budget for any of the fiscal years listed above, please explain the circumstances of this deficit. [Text box]

15. Has your organization had an A-133 audit in the past three years? Yes; No

15. If no, has your organization had a financial statement audit in the past three years? Yes; No

15. Were there any material weaknesses identified in your organization’s 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.)

15. If yes, please explain. [Text box]

15. Number of full-time paid organization staff: _________ Number of part-time paid organization staff: __________

Number of full-time unpaid organization staff Number of part-time unpaid organization staff

(including volunteers): ___________________________ (including volunteers): ____________________________

15. Total number of days the organization was open to the public for the past 12-month period prior to application: ____

15. Name of Nominating Individual: _____________________________________________________________________

Title: _________________________________________ Relationship to Organization: _______________________

E-mail: _______________________________________ Telephone Number: _______________________________

In addition to the Cover Sheet (Section A), your submission must include the following parts (Sections B-D below). Do not include additional cover letters, binders, folders, or attachments.

B. Executive Summary and Mission Statement (not to exceed one single-spaced page; no less than 12-point type)

• Summarize why you believe this organization deserves to win the National Medal for Museum and Library Service.

• Provide this organization’s mission statement or statement of purpose as well as a brief institutional history.

3. Narrative (not to exceed four single-spaced pages; no less than 12-point type)

The National Medals are designed to recognize outstanding libraries and museums that have made significant contributions in service to improve the wellbeing of their communities. These institutions exceed expected levels of community outreach beyond a single program or exhibit by building community cohesion and serving as catalysts for positive community change. Nominees should review the IMLS strategic plan and highlight how their work aligns (e.g., promoting lifelong learning, building institutional capacity, increasing community access). We are particularly interested in enhanced services for veterans/military families, sustained opportunities for diverse youth and young professionals, and assistance to marginalized young families or seniors. Address questions 1-4 thoroughly and succinctly. The jurors considering the pool of potential medal recipients will focus carefully on your answers to these questions.

1. Describe the community⁸ and the particular community needs addressed.

• Quantify and describe the population groups/communities your organization is reaching through its programs, services, and/or partnerships.

• What particular community needs do you address?

• How did you identify these particular needs and work with the community to craft solutions?

• How are these needs incorporated into your organization’s strategic plan?

• How do your institutional culture, values, and strategies align with this community work?

2. Describe the programming your organization has developed for these particular community needs. (See section C.1.)

• Please include a brief description of your full portfolio of services, even if you focus on a particular area of service.

• How do you involve your community in the development of your programs?

• How have these partnerships increased your ability to reach out to the targeted population groups and communities you serve?

• Describe how you serve community members with special needs. You should address accessibility for people with disabilities.

• Organizations applying in the Digital Library category, should address:

  • services to your community including services to other organizations and services to end users;

  • how an understanding of audiences, either current or potential, has driven the approach to providing access to your organization's programs and resources;

  • sustainability and preservation plans for the digital library; and

  • accessibility for people with disabilities.

3. Describe what impact your organization’s programs and services have had on the identified community needs.

• Describe the evaluation you conduct of your programs (qualitative and/or quantitative). How has this information informed the programs? What have you learned about your audience(s)?

• If you do not have a formal evaluation of programs, how do you measure success?

• How have you used this information to plan other programs and services?

4. Describe your organization’s financial context in light of your community programming.

• List your organization’s three primary sources of revenue. Do you have a sustainable funding model that will enable growth for these particular programs?

• Describe any private or non-profit groups that support your mission and activities and the extent of their support.

D. Letters of Support (required - three maximum, submitted with the Nomination Form)

• These letters should come from community members who have direct knowledge of the organization’s community service and the particular programs in your nomination. We recommend that the letters come from different segments of the broader community served by the institution and from individuals who have either witnessed or experienced first-hand a particular program or service.

• Nomination letters from members of Congress are welcome and will not count against the three-letter maximum.

• Address letters to the Director of the Institute of Museum and Library Services and include them with this Nomination Form.

Website – https://www.imls.gov/grants/available/national-medal-museum-and-library-service

Deadline: October 01, 2018

Download FY 2019 Nomination Form (Fill-in PDF, 520KB)

Visit the National Medals page in our National Initiatives section to learn more about the annual celebration of the National Medal recipients.

Program Overview:

The National Medals are designed to recognize outstanding libraries and museums that have made significant contributions in services to improve the wellbeing of their communities. These institutions exceed expected levels of community outreach beyond a single program or exhibit by building community cohesion and serving as catalysts for positive community change. Nominees should review the IMLS strategic plan and highlight how their work aligns (e.g., promoting lifelong learning, building institutional capacity, increasing community access). We are particularly interested in enhanced services for veterans/military families, sustained opportunities for diverse youth and young professionals, and assistance to marginalized young families or seniors.

Recipient institutions are honored at an awards ceremony that is held in Washington, DC.

Nominations should describe the:

• population served and community needs;

• institution’s programs, services, and partnerships;

• impact and evaluation of programs; and

• financial sustainability.

How are the recipients of the National Medal selected?

The Director of the Institute of Museum and Library Services, with the advice of the Museum and Library Services Board, selects the recipients of the National Medals. In addition to the Medal, IMLS may grant a monetary award.

When are the recipients of the National Medal announced?

The recipients of the National Medals are usually announced in the spring on the IMLS website and through a press release.

Who is eligible for a National Medal?

For museums:

• Aquariums, Arboretums/Botanical Gardens, Art Museums, Children’s/Youth Museums, General Museums, Historic Houses/Sites, History Museums, Natural History/Anthropology Museums, Nature Centers, Planetariums, Science/Technology Museums, Specialized Museums, and Zoos may be nominated for the National Medal for Museum Service if they: are either a unit of State or local government or a private nonprofit organization that has tax-exempt status under the Internal Revenue Code;

• are located in one of the 50 States of the United States of America, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of the Marshall Islands, the Federated States of Micronesia, or the Republic of Palau; and

• qualify as a museum that, using a professional staff, is organized on a permanent basis for essentially educational or aesthetic purposes; owns or uses tangible objects, either animate or inanimate; cares for these objects; and exhibits these objects to the general public on a regular basis through facilities that it owns or operates.

A public or private nonprofit agency which is responsible for the operation of a museum may apply on behalf of the museum.

For libraries:

• Academic and Research Libraries/Archives, Digital Libraries, Library Associations, Library Consortia, Public Libraries, Research Libraries/Archives that make information available to the public and that are not an integral part of an institution of higher learning, Public School Libraries, Tribal Libraries, and Private or Special Libraries that are considered libraries as determined by the State in which they are located, may be nominated for the National Medal for Library Service. They should also be: either a unit of State or local government or be a private nonprofit organization that has tax-exempt status under the Internal Revenue Code; and

• located in one of the 50 States of the United States of America, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of the Marshall Islands, the Federated States of Micronesia, or the Republic of Palau.

Previous library or museum medal recipients may reapply after ten years.

Libraries or museums that employ or are affiliated with a current member of the IMLS National Museum and Library Services Board (NMLSB) are not eligible for a National Medal, per resolution of the NMLSB.

Who may nominate a library or museum for the National Medal?

Anyone, including the institution’s employees, board members, members of its community, and elected officials, may nominate a museum or library for this honor.

What steps should nominators take?

• If an institution self-nominates, it simply needs to submit the nomination materials to IMLS by the deadline.

• If someone outside of the institution wants to make a nomination, they should notify the museum or library directly and ask them to complete and submit the nomination form in advance of the deadline.

What information is necessary in order for an institution to be considered for the National Medal and who is responsible for providing it?

Your institution, not the individual who nominates it, must complete the Nomination Form and include the following four parts:

1. Cover Sheet

2. Executive Summary & Mission Statement

3. Narrative (four questions)

4. Letters of Support

Do not include additional cover letters, binders, folders or attachments. For detailed information on answering parts B-D, refer to the Nomination Form.

What is the deadline for submitting the Nomination Form?

The Nomination Form and letters of support should be sent by October 1, 2018, to this email address: [email protected]

Alternatively, nominations may be mailed and postmarked by October 1, 2018, to this address:

The National Medal for Museum and Library Service

Office of the Director

Institute of Museum and Library Services

955 L’Enfant Plaza North, SW, Suite 4000

Washington, DC 20024-2135

For more information about the National Medal for Museum and Library Service contact [email protected] or call (202)653-4757

1 If your organization is not an eligible entity on its own, then enter the name and address of the eligible entity under “Legal Name.” For example, if a library that is part of a parent organization such as a university is applying, it would enter the university under “Legal Name” and the library under “Organizational Unit.”

2 A museum with collections representing two or more disciplines (e.g., art and history)

3 A museum with collections limited to one narrowly defined discipline (e.g., textiles, stamps, maritime, ethnic group)

4 Verify that your organization has a D-U-N-S® Number or take steps to obtain one. Your organization can receive a D-U-N-S® Number at no cost by calling the dedicated toll-free D-U-N-S® Number request line at 1-866-705-5711 or by visiting www.dnb.com/us.

5 Congressional Districts can be found by entering the zip code of the institution at www.house.gov/representatives/find.

6 For nonprofit tax filers Total Revenue can be found on line 12 of the IRS Form 990.

7 For nonprofit tax filers Total Expenses can be found on line 18 of the IRS Form 990.