Name of Network Member Institution

Network Member LIBID

FEIN (Taxpayer ID#)

Project manager name

Mailing address

Telephone number (e.g., 555-555-5555)

Fax number (e.g., 555-555-5555)

Email address (e.g., maryc@project.org)

Business Office/Sponsored Programs Office Contact Information

Business Office Contact Email Address

Title of meeting/conference

Target Population Needs Assessment

Who is the target population or audience for this exhibit? Provide the numbers and types of health care professionals, librarians, and/or consumers
(i.e. the target population) that you expect to reach.

What are the specific needs of this target population?

What is your rationale for selecting this meeting? Why it is appropriate to the NN/LM outreach mission?
Special consideration will be given to applications for exhibits that address the outreach priorities of the NN/LM MAR Strategic Program Plan for Member Participation.

Exhibit Plan

Describe the exhibit. What are the exhibit/meeting objectives? What activities are involved in this exhibit?

Date(s) and location of exhibit (e.g. November 12-13, 2009 in Philadelphia, PA)

Provide the name and description of the primary organization sponsoring the meeting, including the mission of the organization.

Who are the personnel who will be involved in the activity? Provide a list of the key personnel for the project and describe each person's responsibilities. Submit resumes/curriculum vitae for key personnel via email, postal mail, or fax. If you are partnering with other organizations, send letters of support from those organizations via email, postal mail, or fax.

Describe the exhibit booth arrangement. Include booth size, number of tables and size, whether there is electricity and/or Internet access, etc.

Describe topics to be covered and the materials to be distributed during the exhibit. Include both promotional materials to be provided by MAR (http://nnlm.gov/mar/outreach/materials.html or http://www.nlm.nih.gov/pubs/factsheets/) and those to be provided by the awardee’s institution.

If training and/or demonstrations are included, describe what will be taught or demonstrated, who will do it, length of class, type of continuing education credit, and type of training materials. Sample materials may be emailed or faxed to MAR.

Using the fields below, provide an itemized budget for your exhibit:

Booth Rental Fee

Meeting Registration Cost

Publicity/Promotional Material Cost

Electricity cost

Telephone/Data Lines

Equipment Rental cost

Travel cost

Other cost (Provide detail below)

Total amount requested (Maximum $2,000)

Budget justification: Please describe the types of expenditures that you have included in each budget category above and explain why they are needed.

Evaluation

How will you evaluate the success of the exhibit? Develop evaluation criteria to explain how the exhibit objectives will be achieved. In developing the evaluation component, consider what is expected to be different once the exhibit is complete.

Click "Submit" to email your application to MAR. Any supporting documentation should be faxed to MAR at 212.263.4258