Library Services & Technology Act (LSTA) Direct Grant Program

General Application Form

Due to MBLC by Friday, April 8, 2016

Please check grant category
 Citizenship Corners and Expanded English Language Services for New Americans /  Full STEAM Ahead /  Readers’ Advisory
 Conserving and Digitizing Historical Resources /  Innovative “Open” Project /  Science is Everywhere
 Customer Experience /  Jobs/ Career Information for Your Library /  Serving People with Disabilities
 Financial Literacy for All Ages /  Mind in the Making /  Serving Tweens and Teens
 Framework for Health Literacy /  Preservation Assessment
Title:
Institution/ Library
Address
City, Zip
Library Director
Signature
Institution Governing Authority & Title
Signature
Project Director & Title
Phone
Email
Address if different than above
Amount Requested / $
Please check length of project proposed. / 1 Year Project:  / 2 Year Project: 

Table of Contents

Abstract

Section 1 Library/School/Community/ Institution Background

Section 2 Project Management

Section 3 Project Budget

Section 4 Appendices (Please list others as needed)

  1. Project Personnel
  2. Project Timeline
  3. Pre- and Post- Survey
  4. Indirect costs
  5. Letters of Commitment/ Letters of Support

Abstract

Describe the project in 150 words or less, covering what the identified need is, how you are proposing to address the need, and who will benefit. Tip: Write this after you have written and reread your complete grant application.

Section 1: Library/School/ Community/Institution Background

Population of Municipality/ Community
U.S. Congressional District
Current Total Library Budget
Number of FTE Library Staff

Provide a description of the library and the community /institution/campus it serves. Include information on the services that the library supplies to residents, student body, faculty, etc.

Section 2: Project Management

Answer the following questions to explain the project that you envision

  1. What problem and/or need will be addressed by the project you are proposing?
  1. Who will be served by this project? (explain this group, age, demographics, why this group was chosen)
  1. Why do you think this is the best solution to address the problem and need?
  1. What goals to do want to achieve with this project? What strategies and activities will you use to achieve these goals? What resources, inputs, and partners can you draw upon for this project?
  1. What outcomes and outputs do you expect from this project?
  1. How will you evaluate this project? What evaluation tools will you use?
  1. What long term impacts do you hope to achieve by this project? How will you sustain this project?

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Section 3: BudgetYear Covered: ______

Expenditure Type / Description (Narrative)
Detail / LSTA / Cost Share / Totals
  1. Salaries/wages/benefits for staff directly contributing to project activities

Salaries
Fringe Benefits
Total Salaries/wages/benefits
  1. Expenses related to acquiring the services of a consultant for the project. Costs may include fees, travel, accommodation, meals, etc.

Consultant fees
Presenters/ Speakers / Performers
  1. Expenses for travel related to the project (not including Consultant Travel)

  1. Expenses for consumable items necessary to carry out the project

Books/Periodicals (print)
Digital Media
DVDs/CDs/Videogames
Software
Supplies
Furniture
Hardware
Postage
Printing
Other
Total Expenses for consumable items
  1. Expenses for the purchase of equipment/furniture required to carry out the project
/ Use this category for each piece of equipment or furniture that costs $5000 or more. Otherwise show these expenses in Section 4.
Total Expenses for purchase of equipment
Expenditure Type / Description (Narrative)
Detail / LSTA / Cost Share / Totals
  1. Expenses related to the use of third-party contractors to carry out the project (Not Consultant contracts see #2)

Licensing of Databases
Licensing of E Books
Equipment Maintenance
Other
Total Expenses related to ……..
  1. Other Operating Costs

Indirect Costs
Audit
Total Other Operating Costs
Totals

If your application is for a 2 year project please fill out a separate budget for each year.

Section 4: Appendices

All applicants must include information on project personnel, project timeline, survey instruments and letters of support or formal commitment letters; add other appendices as needed.

Project Personnel

Complete this chart for all personnel involved with this project. You may also use this form for anyone that will be working on the project but does not have a resume.

Name
Current Position and Duties
Description of Project-Related Work
Educational/Professional Experience Applicable to this Project
Estimated Number of Hours
If this person is currently employed by the library, total number of hours currently working per week
Number of hours person will spend on the project per week
Total number of weeks that person will spend on the project.
Total Number of Hours of Project-Related Work
Paid with LSTA Funds 
Name
Current Position and Duties
Description of Project-Related Work
Educational/Professional Experience Applicable to this Project
Estimated Number of Hours
If this person is currently employed by the library, total number of hours currently working per week
Number of hours person will spend on the project per week
Total number of weeks that person will spend on the project.
Total Number of Hours of Project-Related Work
Paid with LSTA Funds 

TimelineYear Covered: ______

The grant year begins October 1st and ends September 30th. (Supply second timeline for 2 year project.)

October – December

January – March

April – June

July – September

Pre- and Post- Surveys

Evaluation is a key component of every LSTA grant. Pre- and post- surveys can measure the impact of a program on individuals and is one way to tell the success story of the grant. A pre-survey can provide support of the type of programs that you offer in the project and the post- survey can show if the project had an impact. Pre- and post-surveys are now a component of every grant. Below are sample questions that you may use to conduct pre- and post- surveys. You may develop your own survey questions. This is the section to show the survey questions that you will be using. Use the survey that applies to the activity that you are measuring.

Instructions: For each category below, rate the following statements:

For programs, workshops and other instruction activities

Statement / Strongly agree / Agree / Neither agree/nor disagree / Disagree / Strongly disagree
This program / instruction improved my knowledge
I am likely to use / apply what I learned.
I will use this learning in searching for a job / career.
I will use this learning to assist my family.
I am likely to use this library service again.
I am now more likely to think of the library as a place that can provide assistance.

For content purchased to support the project (Content could be physical and /or electronic materials):

Statement / Strongly agree / Agree / Neither agree/ nor disagree / Disagree / Strongly disagree
This resource provided me with the information that I needed.
I will use this information in my job / career / school work.
I am more likely to think of the library as a place to find information and answer my questions.

Indirect Costs

The Federal Office of Management and Budget (OMB) issued new guidelines for Administrative Costs (2 CFR 200). One of the new guidelines is to allow grantees to allocate a portion of their grant award toward indirect costs. An indirect cost is an organization’s incurred cost that cannot be readily isolated or identified with just one project or activity. These costs are often referred to as overhead; some examples would be telephone, postage, office supplies, office space expenses, administrative or financial operations for the organization.

The Office of Management and Budget (OMB) gives you, the grantee, four options for including indirect costs:

  1. Use a current indirect cost rate already negotiated with a federal agency. Municipalities or schools, universities may have done negotiated a rate.
  2. Use an indirect cost rate proposed to a federal agency but not yet approved. You would need to provide copy of application.
  3. Use a rate not to exceed 10% of modified total direct costs if you have never had a federally negotiated indirect cost rate.
  4. Not include any indirect costs.

If you do not have a federally negotiated rate, you may choose to charge the rate of 10% of modified total direct costs (MTDC). MTDC means all direct salaries and wages, applicable fringe benefits, office supplies, services, travel for grants equaling $25,000 or less. If you use this rate you must be careful to exclude from the budget all indirect-cost-type items, such as telephone, postage, office supplies. You may use this rate without any further documentation.

If your municipality, university, organization or school has negotiated or is in the process of negotiating a rate with another federal agency, you may use that rate. You must include a copy of the negotiated rate agreement or a copy of the indirect cost proposal that another federal agency is in the process of negotiating with you.

Please complete the following and provide signature and date. If you are taking Indirect costs, they should appear in the budget section “Other Operating Costs”.

The library chooses the following option for Indirect Costs

______Current indirect costs rates have been negotiated with a federal agency.

Name of Federal Agency: ______

Expiration Date: ______

Please include a copy of this negotiated rate agreement.

____ Indirect cost proposal has been submitted to a federal agency, but not yet negotiated.

Name of Federal Agency: ______

Date of Proposal: ______

Please include a copy of the proposal

______Applicant choose a rate not to exceed 10% of modified total direct costs, and declares it is eligible for the 10% rate.

______Applicant choose not to include indirect costs.

Signature: ______Date: ______

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