InternetSafety_public libraries

InternetSafety_public libraries.docx

Grants to States Program “State Reporting System

InternetSafety_public libraries

OMB: 3137-0071

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INTERNET SAFETY CERTIFICATION FOR APPLICANT PUBLIC LIBRARIES,

PUBLIC ELEMENTARY AND SECONDARY SCHOOL LIBRARIES, and CONSORTIA WITH PUBLIC AND/OR PUBLIC SCHOOL LIBRARIES



As the duly authorized representative of the applicant library, I hereby certify that the library is (check only one of the following boxes)



A. 􀂉 CIPA Compliant (The applicant library has complied with the requirements of 20 U.S.C. § 9134(f).)

OR


B. 􀂉 The CIPA requirements do not apply because no funds made available under the LSTA Grants to States program are being used to purchase

computers to access the Internet or to pay for direct costs associated with accessing the Internet.




__________________________________________

Signature of Authorized Representative



__________________________________________

Printed Name of Authorized Representative



__________________________________________

Title of Authorized Representative



__________________________________________

Date



__________________________________________

Name of Applicant Library/Program



OMB No. 3137-0071; Expiration Date: XX/XX/XXXX

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorTeresa A. DeVoe
File Modified0000-00-00
File Created2021-07-08

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