Continuing Education Grant Application

*Indicates field to be filled out.
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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: *
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 if 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: *
Additional comments: