Name of applicant

Name of network member institution

LIBID

FEIN (Taxpayer ID#)

Mailing address

Email Address

Day time telephone number (e.g. 555-555-5555)

Fax Number (e.g. 555-555-5555)

Are you currently an EFTS Library?
Yes
No

For non-EFTS Libraries—
Please describe how you would promote EFTS to your administrators so that you will be able to sustain your membership after this initial funding

For non-EFTS Libraries—
If available, please provide any statements or pledges of support from your administrator for your participation in EFTS. 

For non-EFTS Libraries—
Please state how frequently you borrow for cost and/or an estimate of your ILL expenditures for the past year.

For non-EFTS Libraries—
Please provide the name and contact information for your administrator.  NN/LM MAR will use this information for promotional purposes to encourage administrator’s continued support of the EFTS program after the initial starter funds.

For Current EFTS Members—
Please state how frequently you borrow for cost and/or an estimate of your ILL expenditures for the past year.

For Current EFTS Members—
Please state briefly your reasons for requesting additional funds
(e.g. increased requests, promotion of resource sharing to specific audiences or for outreach, etc.).

Total amount requested (for non-EFTS libraries up to $200; for current EFTS members up to $500)

to the MAR office for review