*Name of person filling out form

*E-mail of person filling out form

*Participant's name

*Library

*Job title/position

*Name of conference or workshop

*Date of conference or workshop

*Location of conference or workshop

*Explain in space provided why you think this event will be beneficial to you or your staff member in your/their job

*Are you a library director or head librarian for your library? Yes No

*Have you previously received a CE Grant? Yes No

If yes, when?

*Has your library board agreed to reimburse your travel expense
and arrange for substitute help in your library if needed? Yes No

*Do you agree to return or relinquish
your claim to CE Grant funds awarded in the event you do not attend the event? Yes No

*Cost of registration $

*Please provide a link to the event you are applying for or enter the words no link

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