New York State Library Division of Library Development

Discretionary Grant Application Workbook

THE NEW YORK STATE PROGRAM FOR THE CONSERVATION AND PRESERVATION OF LIBRARY RESEARCH MATERIALS

200-/0- APPLICATION DISCRETIONARY GRANT PROGRAM

COVER SHEET

Submit four copies of this application. Original signatures are required on each copy of the Institutional Authorization. Applications must be received in this office by 5:00 p.m. December -, 200-. Submit to:

Conservation/Preservation Program
Division of Library Development, New York State Library
10-C-47 Cultural Education Center, Albany, NY 12230; (518) 474-6971

Name of Institution:

___Booktown Public Library______

Mailing Address:

___111 Library Lane____________

___Booktown, NY     00001______

County:_Albany____

Director:__Beatrice Bibliophile_______Director____________ phone:518-111-1111_____                            (name)                          (title)

PROJECT TITLE:____Collection Preservation and Microfilming Project_______________

SUMMARY DESCRIPTION:

Provide a clear, concise summary of the project,
not to exceed the space available on this page

AMOUNT REQUESTED:$_11,050___

Project
Manager:__Beatrice Bibliophile_______Director____________ phone:518-111-1111_____                            (name)                          (title)

List districts in which your institution or agency is located:

State Judicial____1_______________________State Assembly ___1___________________

State Senate____1_______________________Congressional ___1_____________________

Is the institution's major source of funding _x_ public or ___ private?

INSTITUTIONAL ELIGIBILITY

    1. Type of agency - check most appropriate category:

      2. _x_ Library                         ___Archives

      ___Academic/research        ___Museum

      _x_Public                            ___Historical Society

      ___Other:__________       ___Other:___________

    2. Indicate the basis of the institution's eligibility to apply for discretionary grant funds:

      3. _x_chartered by the Board of Regents of the State of New York;
            date of charter:_October 12, 1911__

      ___accepted by the Board of Regents of the State of New York for filing under the
            not-for-profit section (Section 216) of the Education Law;
            date of acceptance:______________

      ___registered with the Office of Charities of the New York State Dept. of State;
            date of registration:______________

      ___granted not-for-profit status under section 501(c)(3) of the United States Internal
            Revenue Code; date:_____________

      ___Other. attach a detailed explanation including a description of the agency's
            organization, legal establishment, governance, sources of support, and services.

    3. Is the institution affiliated with a religious denomination?

      4. _x_ No  ___ Yes    If yes, the application must be accompanied by evidence of
                                     constitutional eligibility to receive state financial assistance.  
                                     Guidelines, page 2.

    4. Previous Discretionary Grant awards; check each year in which the institution has received a grant award:

                    ___1985/86   ___86/87   _x_87/88   ___88/89   _x_89/90   ___90/91

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Last modified on February 2, 2000/djr
For questions or comments contact Barbara Lilley
URL: http://www.nysl.nysed.gov/libdev/cp/scover.htm