ACRL Scholarship Application

Information

ALA Membership No.:

Length of ACRL Membership:

Name of ACRL Event:

Your Name:

Current position title:

Date started:

Institution:

Mailing Address:

City, State, Zip:

E-mail:

Phone:

Your current salary:

Library Director’s Name:

MLS degree earned in year:

at (name of institution):

Your ethnic background (check only one)

_____ African-American
_____ Asian/Pacific Islander
_____ Caucasian
_____ Hispanic/Latino(a)
_____ Native American
_____ Other (specify)

Library Employment History

Please list below positions held prior to current position:
Institution/Title
From
To
     
     
     

Type of library currently employed by:

_____ College Library
_____ Community & Junior College Library
_____ Private Sector/For Profit University
_____ University Library


Amount of funding requested: $_________________________

________________________________
Signature of Library Director

________________________________
Date

I certify that the information that has been provided is correct. I understand that the Scholarship Committee will keep this information confidential.

________________________________
Signature

________________________________
Date

Unless otherwise specified by the particular ACRL scholarship you are applying for, send to:

ACRL Scholarships
50 East Huron Street
Chicago, IL 60611