APPLICATION FOR APPROVAL OF A REVISION TO A PUBLIC LIBRARY SYSTEM PLAN OF SERVICE

January 1, 2002 - December 31, 2006

PURSUANT TO EDUCATION
LAW §255, §272, §273
SECTION 90.3 OF THE REGULATIONS
OF THE COMMISSIONER OF EDUCATION

Name of Library System:__________________________________________________________________________

Address of Library System:_________________________________________________________________________

Address of Library System:_________________________________________________________________________

The application for approval of the public library resources system Plan of Organization and Service is hereby submitted in accordance with outlined requirements and approved by the persons listed below:

(date)__________________________________ (signed)__________________________________
                                                                                                          President, Library System Board of Trustees

(date)__________________________________ (signed)__________________________________
                                                                                                          Library System Director

Return to:

The University of the State of New York
State Education Department
Division of Library Development
Cultural Education Center - Room 10B41
Albany, New York 12230


SED USE ONLY

________________________________  ___________________________________________________
         approval date                                                                     State Education Department approval
Last Updated: August 12, 2009