Form Application Form 8 Application Form 8 National Award for Library and Museum Services Nominatio

2010 Nomination
National Medal for Museum and Library Service
Deadline for FY 2010: February 16, 2010
Program Contact for Libraries:
Michele Farrell, Senior Program Officer
Phone: 202-653-4656
E-mail: mfarrell@imls.gov

Program Contact for Museums:
Christopher Reich, Senior Program Officer
Phone: 202-653-4685
E-mail: creich@imls.gov

Program Overview
The National Medal honors outstanding institutions that make significant and exceptional contributions to their
communities. Selected institutions demonstrate extraordinary and innovative approaches to public service,
exceeding the expected levels of community outreach, and may also include libraries and museums advancing
global cultural understanding across borders.
Nominations should describe:
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the institution’s goals in serving its community,
the population served,
how the institution works together with the community to achieve the goals,
the outcome of this effort during the past two to three years,
projections for future efforts, and
how the institution will sustain these efforts in the future.

The National Museum and Library Services Board reviews the nominations and makes recommendations to the
IMLS Director, who makes the final selection.
Eligibility
Institutions that fulfill the general criteria may apply. See www.imls.gov/applicants/criteria.shtm for details.
Institutions that have won an award may be renominated after 10 years.
Nomination Information
A library or museum may be nominated by one of its own employees or by a member of the community with
a special interest in the institution. If you are an employee of the museum or library you are nominating, please
state your title. If you are a member of the community, please indicate your particular interest in the institution.
The nomination must be completed by the nominated institution, and it must include the following five parts.
Do not include additional cover letters, binders, folders or attachments. For parts B-E, see page three of the
Nomination Form.
A.
B.
C.
D.
E.

Cover Sheet (pages one and two of the attached Nomination Form)
Statement of Purpose/Mission Statement & Brief Institutional History
Narrative
Institutional Financial Statements
Letters of Support

Nominations must be postmarked by February 16, 2010 to this address (no faxes or emails will be accepted):
The National Medal for Museum and Library Service
Office of the Director
Institute of Museum and Library Services
1800 M St. NW 9th Floor
Washington, DC 20036-5802

2010 Nomination Form—Page One
National Medal for Museum and Library Service
(To be filled out by the nominated institution.)
A. Nomination Cover Sheet
1. Legal Name of Nominated Institution:1

Organizational Unit (if different from Legal Name):

2. Institution Address
Street1:

Street2:

City:

County:

State:

Zip+4/Postal Code:

3. Telephone Number:

4. Fax Number:

5. Web Address: http://

6. Name of Institution’s Director/CEO:

Title:

E-mail:

Telephone Number:

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Nature Center
Planetarium
Public Library
Research Library/Archives
School Library, or School District applying
on behalf of a School Library or Libraries
Science/Technology Museum
Special Library
Specialized Museum3
Zoo
Other, please specify:

7. Type of Institution (check one):
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Academic Library
Aquarium
Arboretum/Botanical garden
Art Museum
Children’s/Youth Museum
General Museum2
Historic House/Site
History Museum
Library Association
Library Consortium
Museum Library
Natural History /Anthropology Museum

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If your institution is not an eligible entity on its own, then enter the name and address of the eligible entity under
“Legal Name.” For example, a library that is part of a parent organization, such as a university, is applying, would enter the
university under “Legal Name” and the library under “Organizational Unit.”
2
A museum with collections representing two or more disciplines equally (e.g., art and history)
3
A museum with collections limited to one narrowly defined discipline (e.g., textiles, stamps, maritime, ethnic group)
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2010 Nomination Form—Page Two
National Medal for Museum and Library Service
(To be filled out by the nominated institution.)
A. Nomination Cover Sheet (continued)
8. Governing Control (check one):
State Government
County Government
City or Township Government
Special District Government
Regional Organization
U.S. Territory or Possession
Independent School District
Public/State-Controlled Institution of Higher Education
Indian/Native American Tribal Government (Federally
Recognized)
 Indian/Native American Tribal Government (Other
than Federally Recognized)
 Indian/Native American Tribally Designated Organization
 Public/Indian Housing Authority
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 Nonprofit with 501(c)3 IRS Status (Other than Institution
of Higher Education)
 Nonprofit without 501(c)3 IRS Status (Other than
Institution of Higher Education)
 Private Institution of Higher Education
 Individual
 For-Profit Organization (Other than Small Business)
 Small Business
 Hispanic-serving Institution
 Historically Black Colleges and Universities (HBCUs)
 Tribally Controlled Colleges and Universities (TCCUs)
 Alaska Native and Native Hawaiian Serving Institutions
 Nondomestic (non-U.S.) Entity
 Other (specify)

9. Nominated Institution’s D-U-N-S® Number:4
10. Nominated Institution’s Employer/Taxpayer Number (EIN/TIN):
11. Congressional District of Nominated Institution:
12. Institution’s Annual Budget:
13. Complete either a or b:

b. Attendance – onsite:

a. Population served:

Attendance – offsite:

14. Number of full-time paid institution staff:

Number of part-time paid institution staff:

Number of full-time unpaid institution staff (including

Number of part-time unpaid institution staff (including

volunteers:

volunteers):

15. Total number of days the institution was open to the public for the 12-month period prior to application:

16. Name of Nominating Individual:

Title:

Relationship to Institution:

E-mail:

Telephone Number:

Verify that your institution has a D-U-N-S® Number or take steps to obtain one. Your institution can receive a D-U-N-S® Number
at no cost by calling the dedicated toll-free D-U-N-S® Number request line at 1-866-705-5711 or by visiting www.dnb.com/us.

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2010 Nomination Form—Page Three
National Medal for Museum and Library Service
(To be filled out by the nominated institution.)
In addition to the Cover Sheet (Section A), the nomination must include the following parts (Sections B-E below).
Do not include additional cover letters, binders, folders or attachments.

B. Statement of Purpose/Mission Statement & Brief Institutional History

Provide your institution’s mission statement or statement of purpose as well as a brief institutional history (not to exceed one
single-spaced page; no less than 12-point type).

C. Narrative

Address questions 1–4 thoroughly and succinctly (not to exceed five single-space pages; no less than 12-point type). If you choose
to answer question 5, please add an additional page. The jurors determining the pool of potential award winners will focus closely
on your answers to these questions.
1.

Quantify and describe the population groups/communities your institution is reaching through its community services and
provide examples of the programs and services that have been developed for these communities. How does your institution work with other organizations within the broader community to provide exemplary programs and services? Describe
your organization’s leadership role in these activities.

2. What are your institution’s goals for 21st century community service? How do these goals reflect your institution’s mission

and strategic plan? How do they reflect an assessment of the broader community’s learning or informational needs?
3. Describe how your institution’s programs and services have an impact on addressing community issues, and what you have

learned from evaluation activities about meeting the needs of audiences?
4. How does your institution ensure that it will be able to sustain these commitments to the community?
5. (Optional) Describe how your institution has reached beyond U.S. borders to advance cultural understanding in the U.S.

and abroad.

D. Institutional Financial Statements

Include a copy of your institution’s financial statements for the past two complete fiscal years. If at time of nomination your fiscal
year is complete but not yet audited, please submit these unaudited figures and label as such.
If your institution is part of a larger organization (municipal government, university, etc.) do not include financial statements for
the parent organization, only for the nominee.

E. Letters of Support

Your institution may submit up to three letters of support with the nomination. These letters should come from community members who have direct knowledge of the institution’s community service. It is recommended that the letters come from different
segments of the broader community served by the institution. These letters should be addressed to the Director of the Institute of
Museum and Library Services and included with the nomination mailing.
Nominations must be postmarked by February 16, 2010 to this address (no faxes or emails will be accepted):
The National Medal for Museum and Library Service
Office of the Director
Institute of Museum and Library Services
1800 M St. NW 9th Floor
Washington, DC 20036-5802