Form Museum CAP PIF For Museum CAP PIF For Museum CAP PIF Form

IMLS MUSEUM PROGRAM INFORMATION FORM

PLEASE NOTE: Information contained within this form may be published online or otherwise shared by IMLS. Therefore, please do not include any sensitive, proprietary, or confidential information.

Section 1. Organizational Financial Information

1. Please complete the following table for the Organizational Unit for the three most recently completed fiscal years.

Fiscal Year	Total Revenue*	Total Expenses**	Surplus or Deficit

* For nonprofit tax filers, Total Revenue can be found on Line 12 of the IRS Form 990.

** For nonprofit tax filers, Total Expenses can be found on Line 18 of the IRS Form 990.

2. If the Total Revenue amounts declined by more than 15% for any year over year listed OR if there was a deficit of more than 10% of the Total Revenue for two or more years listed above, explain the circumstances in the box below.

3. Were there any material weaknesses identified in your prior year’s audit report?

Yes

No

Not applicable

A material weakness is a deficiency, or combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented, or detected and corrected on a timely basis. If yes, please explain in the box below.

4. Has your organization had single or program-specific audit in the past three years?

Yes

No

Section 2. Agency-Level Goals and Objectives

Select one IMLS agency-level goal that best aligns with your proposed project. Once you have selected a goal, please select one associated objective.

Goal 1: Champion Lifelong Learning

Objective 1.1: Advance shared knowledge and learning opportunities for all.

Objective 1.2: Support the training and professional development of the museum and library workforce.

Goal 2: Strengthen Community Engagement

Objective 2.1: Promote inclusive engagement across diverse audiences.

Objective 2.2: Support community collaboration and foster civic discourse.

Goal 3: Advance Collections Stewardship and Access

Objective 3.1: Support collections care and management.

Objective 3.2: Promote access to museum and library collections.

Section 3. Grant Program

Select National Leadership Grants for Museums and Non-research.

National Leadership Grants for Museums

Non-research

Section 4. Museum Profile (Museum Applicants only)

1. Is your organization a public, tribal, or private nonprofit agency or institution?

• Yes

• No

2. Is your organization organized on a permanent basis for essentially educational, cultural heritage, or aesthetic purposes?

• Yes

• No

3. Does your organization own or utilize tangible objects and care for such tangible objects?

• Yes

• No

4. Does your organization exhibit the tangible objects to the general public in a facility that you own or operate?

• Yes

• No

5. What was your institution’s attendance for the 12-month period prior to the application?

• Fewer than 1,000

• 1,000 - 9,999

• 10,000 - 99,999

• 100,000 - 999,999

• 1,000,000 - 9,999,999

• 10,000,000 +

6. How many days was your institution open to the public during these 12 months?

• 0 - 119

• 120 - 249

• 250 - 365

7. Does your organization use a professional staff (i.e., does your organization employ at least one staff member, or the full-time equivalent, whether paid or unpaid, primarily engaged in the acquisition, care, or exhibition to the public of objects owned or used by the organization)?

• Yes

• No

8. Number of full-time paid institutional staff:

• 0

• 1

• 2

• 3

• 4 - 10

• 11 - 50

• 51+

9. Number of full-time unpaid institutional staff:

• 0

• 1

• 2

• 3

• 4 - 10

• 11 - 50

• 51+

10. Number of part-time paid institutional staff:

• 0

• 1

• 2

• 3

• 4 - 10

• 11 - 50

• 51+

11. Number of part-time unpaid institutional staff:

• 0

• 1

• 2

• 3

• 4 - 10

• 11 - 50

• 51+

OMB Control #: 3137-0092, Expiration Date: 08/31/2021