MPLA Grant for Professional Development

Fields noted in RED are required and must be completed for your request to be transmitted.

Your Information

Full Name:

Email:

Mailing Address:

City:

State:

Zip Code:

Business Phone:

Alternate Phone:

Grant Type

Regular Grant ($600 max) Mini Grant ($150 max)

Information About the Program/Presentation

Date(s) of Presentation:

Location of Presentation:

Title or Research Description:

Provide a full description of the program. (If available, send other materials which describe the program or activity to Judy Zelenski, MPLA Executive Secretary, at the address at the bottom of this form.)

Indicate specific objectives to be achieved from the planned program and explain how attainment of these objectives will contribute to your personal growth, future goals, and career development.

Indicate the anticipated benefits to MPLA.

Enter the name, address, and telephone number of person or institution administering the program.

Indicate the full budget of your expected expenses and the amount of those expenses for which you are requesting this grant.

Your Work Experience

Work Experience: list in reverse order beginning with current position, include job title, library/institution/dates. (NOTE: A resume may also be included, but it cannot be a substitute for completing the following requested information.)

Indicate responsibilities and duties of your current position.

Enter the colleges and universities you have attended, in order of attendance, include city/state, year and degree.

Other Information

Are you an MPLA member? Yes No

What years have you been an MPLA member?

Have you previously received an MPLA Professional Development Grant?
Yes No

If yes, what year(s):

For questions or comments, or to e-mail electronic copies or mail hard copies of supporting documentation, contact:

Judy Zelenski
MPLA Executive Secretary
14293 W. Center Drive
Lakewood, CO 80228
Email:mpla_execsecretary@operamail.com