Texas Library Association

TEXAS LIBRARY ASSOCIATION

Diversity & Inclusion Committee

CONFERENCE STIPEND APPLICATION FORM—DIVERSITY APPLICANTS

Stipend to Attend the Upcoming TLA Annual Conference

Completed stipend applications and a letter of recommendation must be postmarked by the published deadline. Applications submitted with incomplete, inaccurate information or without the required letter of recommendation will be eliminated from the review process by the Diversity & Inclusion CommitteeConference Stipend Committee Chair.

*NAME:
JOB TITLE:
LIBRARY:
LIBRARY ADDRESS:
WORK PHONE:
*EMAIL:
FAX:
*OTHER PHONE:
*MAILING ADDRESS:
REFERENCE:
WORK PHONE (REFERENCE):
EMAIL (REFERENCE):
MAILING ADDRESS (REFERENCE):
*TLA MEMBERSHIP NUMBER:
NUMBER OF YEARS AS A TLA MEMBER:
DO YOU HAVE AN MLS OR MLIS? (YES/NO):
INSTITUTION NAME (DEGREE RECEIVED FROM):
ARE YOU CURRENTLY WORKING ON YOUR MLS OR MLIS? (YES/NO):
LIST ANY CERTIFICATIONS:
STATEMENT OF NEED:EXPLAIN WHY YOU DESIRE ASSISTANCE WITH ATTENDANCE AT TLA CONFERENCE.
Describe special responsibilities, areas of interest, or memberships that reflect on your interest in diversity and inclusion initiatives:
Describe how you will meet the volunteer requirement.
Outline your attendance, if any, at library district, system, or conference meetings in the last three calendar years:
Explain how attending this year’s TLA Conference will benefit you and why you want this stipend.

LETTER OF REFERENCE

A letter of reference must accompany the Stipend Form. An incomplete submission will be eliminated from the review process.

PLEASE READ CAREFULLY, SIGN, AND DATE:

If chosen as the winner of the Diversity & Inclusion CommitteeConference Stipend to the upcoming TLA Annual Conference, I agree to all the following requirements.

 Apply the stipend first toward registration expenses, including required pre-conferences, and then toward other conference expenses.

 Accept volunteer assignments during the conference as assigned by a Diversity & Inclusion CommitteeCo-Chair.

 Attend the D&I Membership/Business Meeting.

 Attend all D&I sponsored or co-sponsored programs and events during the conference.

 Submit a report evaluating the conference, stating whether it fulfilled expectations, and what was learned that can be used in the recipient’s library. Report must be written and submitted to the Junior Library Guild/Diversity & Inclusion CommitteeConference Stipend Committee Chair within 30 days of the end of the conference.

Signature:______Date:______

The completed application form and accompanying ‘Letter of Reference’ must be postmarked on or before March 13, 2015. Send or e-mail to:

Constance Matheny, Chair, Diversity & Inclusion Committee Stipend Committee

1703 Timber Brush Trail

Austin, Texas 78741

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