Minde Browning Professional Development Fund Application Directions Librarians and staff at eligible Marion County libraries must use this form to request funds from the Minde Browning Professional Development Fund. Application should be submitted at least 60 days before the proposed event. Questions: Contact Jamie Valentine, Community Leadership Officer (JamieV@cicf.org) Part I: Contact Information Name * Title * Email * Enter Email Address Confirm Email * Confirm Email Address Name of School * School Address * School Address Street Line 1 Street Line 1 Street Line 2 Street Line 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Part II: Program Details Name and description of opportunity * Date(s) of opportunity * Location of opportunity * Have you participated in this activity before? * Yes No How many times have your participated in this activity before? * How will your participation in this opportunity further your own professional development? * How will your participation benefit your library patrons and/or the larger community? * Part III: Budget If a certain category doesn't apply to your program, please write "$0" or "N/A". Category #1: Registration/Tuition * Category #2: Travel (use federal mileage rate) * Category #3: Lodging * Category #4: Meals (use federal per diem rate for city where event will take place) * Category #5: Other costs * Total Amount From 5 Budget Categories (automatically calculated) $ Request to Minde Browning Fund * $ Please enter an amount between $0 - $1500 Please provide a short budget narrative (2-5 sentences) explaining how costs were determined and explaining what “other costs” includes. * Does your school provide any support for professional development? * Yes No How much is your school contributing to the cost of attending this professional development opportunity? * If this request is not awarded, will you attend the event anyway? * Yes No If you will still attend, please explain how you will cover the costs of the training without Minde Browning funds. * Part IV: Endorsement If awarded, I agree to use the funds as granted. * Yes No If awarded, following the completion of the event, I will submit a report to The Indianapolis Foundation, including any completion record or final grade for the course, if the opportunity is professional coursework. * Yes No My supervisor has read this request and approves the submission of this proposal. * Yes No Supervisor Name * Supervisor Title * Supervisor Email * If you are human, leave this field blank.
