2001-2006 Public Library System PLAN OF SERVICE REVISION FORM

Page 1

Attach "Application for a revision to a Plan of Service" form with original signatures.

Covers Period 1/1/02-12/31/06


1      2      3      4      5
(Circle Revision Number)

PLS Name:


Return to:

Lisa Areford
New York State Education Department
Division of Library Development
10B41 Cultural Education Center
Albany, New York 12230

Date Submitted by agency:___________

 
Complete Columns I and III and attach revisions		 Date Approved:

 

SED use only
Check Appropriate Revised Section

Column I

Column II

Write a brief summary statement of each revised section in Column III and attach the revised section of the plan labeled according to Column II.

Column III

  Section 1. Basic Information  
  A. Name of System:  
  B. Address:  
  C. Phone Number:  
  D. Fax Number:  
  E. E-mail Address:  
  F. URL:  
  G. Date of Establishment:  
  H. N/A  
 

I. System Service Area:

  • Square mileage
  • Population
 
  J. Type of System: Public  
  K. Minimum staffing requirements (FTE)-director and support staff  
 

L. List of Members:

  • Printed
  • Electronic (Word)
 
Go to Page 2 of the form
Last Updated: August 12, 2009