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Express Outreach Award Application

Applications will be accepted only from NN/LM PSR members. Please see http://nnlm.gov/psr/services for details about membership.

The Express Outreach Award Application is a 2-Step process. To apply, you need to fill out STEP 1: Personal/Project Information and then STEP 2 - Project Budget Information.

If you have difficulty completing the application, we suggest that you clear your browser’s cache before trying again. We also recommend saving your work on to a Word document to complete Step 1 of the application, in order to cut and paste the narrative project information into the application. Then, enter the budget information in Step 2.

Let's get started!


STEP 1 - Personal/Project Information

  1. Name of Network Member Institution:


  2. LIBID


  3. Project Manager:


  4. Position Title:


  5. Mailing Address:


  6. Email Address:


  7. Telephone number:


  8. Fax number:


  9. Proposed start date for 12 month project (e.g. July 1, 2006):


  10. Project Title:


  11. Project Summary (250 words or less):


  12. Type of project:
    (check all that apply)

    Training
    Planning
    Resource Development
    Other (please specify below):



  13. Detailed Project Description:


  14. List specific project objectives you hope to achieve:


  15. List the numbers and types of health care professionals, librarians, and/or consumers you expect the project to reach:

    Example: Senior Citizens, Public Health Nurses, AIDS Health Educators



  16. The Network member will work with the following organization(s):
    (check all that apply)

    Community Based Organization
    Local Department of Health
    Public Library
    Support or Advocacy Group
    Other organizations (please specify below:



  17. List name(s), address(es), website(s) (if any) and description(s) of partner organization(s) and key contact person:

    SUGGESTED FORMAT ( feel free to cut 'n' paste! )
    Contact Name: Joan Smith, R.N., Clinic Supervisor
    Organization Name: Our Neighborhood Clinic
    Address: 2211 Main Street
    City, State, Zip: Our Town, CA 94321
    Website: http://www.ourclinic.org
    Description: Non-profit clinic providing outpatient service to primarily immigrant population. Health professionals on staff number 12 and include physicians, nurses, and health educators.



  18. State how you will publicize and promote your project to the target audience:

    Example: Mailings, flyers/announcements, press releases, phone contacts



  19. State how you will evaluate the project and measure the success for each objective: