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2014 e-Learning Scholarships Application

Question Title

1. Applicant Contact Information

First Name

Last Name

Title

Institution

City

State

Zip

Email Address

ALA Membership Number

MLS degree earned in (year)

MLS degree earned at (institution)

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2. I have previously received an ACRL scholarship.

Yes

No

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3. Employment Information.

Current Employment (dates, position, institution)

Prior Employment 1 (dates, position, institution)

Prior Employment 2 (dates, position, institution)

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4. Type of Institution

Research

Comprehensive

Liberal Arts

Two Year

Special Library

Library School

Other (please specify)

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5. Type of scholarship. I am applying for:

Online course scholarship

Webcast scholarship

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6. Please provide a brief statement (approx. 300 words) that describes how participation in an ACRL e-learning webcast meets your professional needs and goals. Box below will allow you to copy and paste from Word.

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7. I certify that the information provided in this application is correct. I understand that the ACRL Professional Development Committee will keep this information confidential. By responding below I confirm that I have read this statement and attest to the truth of all information submitted in my application.

Yes

No