IMLS MUSEUM PROGRAM INFORMATION FORM
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.
If the Total Revenue amounts declined by more than 15% for any year over year listed OR if there was a deficit of more than 10% of the Total Revenue for two or more years listed above, explain the circumstances in the box below.
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 in the
box below.
Has your organization had single or program-specific audit in the past three years?
Yes
No
Select one IMLS agency-level goal that best aligns with your proposed project. Once you have selected a goal, please select one associated objective.
Goal 1: Champion Lifelong Learning
Objective 1.1: Advance shared knowledge and learning opportunities for all.
Objective 1.2: Support the training and professional development of the museum and library workforce.
Goal 2: Strengthen Community Engagement
Objective 2.1: Promote inclusive engagement across diverse audiences.
Objective 2.2: Support community collaboration and foster civic discourse.
Goal 3: Advance Collections Stewardship and Access
Objective 3.1: Support collections care and management.
Objective 3.2: Promote access to museum and library collections.
Select National Leadership Grants for Museums and Non-research.
National Leadership Grants for Museums
Non-research
Is your organization a public, tribal, or private nonprofit agency or institution?
Yes
No
Is your organization organized on a permanent basis for essentially educational, cultural heritage, or aesthetic purposes?
Yes
No
Does your organization own or utilize tangible objects and care for such tangible objects?
Yes
No
Does your organization exhibit the tangible objects to the general public in a facility that you own or operate?
Yes
No
What was your institution’s attendance for the 12-month period prior to the application?
Fewer than 1,000
1,000 - 9,999
10,000 - 99,999
100,000 - 999,999
1,000,000 - 9,999,999
10,000,000 +
How many days was your institution open to the public during these 12 months?
0 - 119
120 - 249
250 - 365
Does your organization use a professional staff (i.e., does your organization employ at least one staff member, or the full-time equivalent, whether paid or unpaid, primarily engaged in the acquisition, care, or exhibition to the public of objects owned or used by the organization)?
Yes
No
Number of full-time paid institutional staff:
0
1
2
3
4 - 10
11 - 50
51+
Number of full-time unpaid institutional staff:
0
1
2
3
4 - 10
11 - 50
51+
Number of part-time paid institutional staff:
0
1
2
3
4 - 10
11 - 50
51+
Number of part-time unpaid institutional staff:
0
1
2
3
4 - 10
11 - 50
51+
OMB Control #: 3137-0092, Expiration Date: 08/31/2021
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | IMLS Program Information Form |
Subject | IMLS Program Information Form |
Author | Talitha Parker |
File Modified | 0000-00-00 |
File Created | 2021-05-17 |