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Name:    _____________________________

Library:    _____________________________

Job Title:    _____________________________

Telephone Number: ______________________   

E-mail Address:__________________________   

Date & Name of School Library Masters Degree was obtained from:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

I am a member in good standing of WLA and have been a member for __ years.

Amount requested (up to $500)    ____________________________

Reference #1 (please have them send letter directly to Scholarship Chair):

Name:            ____________________________________________
Title:            ____________________________________________
Telephone Number:    ____________________________________________
E-mail Address:    ____________________________________________
Capacity in which they know me:    _________________________________

Reference #2 (please have them send letter directly to Scholarship Chair):

Name:            _____________________________________________
Title:            _____________________________________________
Telephone Number: _____________________________________________
E-mail Address:    _____________________________________________
Capacity in which they know me:    ___________________________________


____    I have attached an Outline/Professional Description of the Course, Workshop, Conference or Program you wish to participate in.

____     I have attached my essay of 1000 words or less, (2-3 pages, double-spaced) describing my professional involvement with library service and clearly state the purpose/benefits of my taking the course/workshop, or attending the conference/program. 

____    I understand that: I must use the award monies within 12 months of being selected as scholarship recipient; I will write an article to be posted on the WLA website summarizing my scholarship experience; I will be asked to sign a statement agreeing to give a presentation at a WLA conference (mid-winter/fall or annual) within 12 months of being awarded the scholarship, based upon knowledge gained at the conference or course I attended and will submit a report about my experiences within a month of conference attendance or course completion.

_____    I am aware that I will receive payment of the award monies only upon proof of completion of the course, workshop, conference, or program; and submission of the article for the WLA Website.


Signature: _____________________________        Date:    _________

Please remit to WLA Awards Chair, Karen Zielinski c/o Scarsdale Public Library 54 Olmsted Rd, Scarsdale, NY 10583 by March 31, 2008.  E-mail submissions are welcome, please send them to: ladybugger67@yahoo.com

Last modified on 2/14/2008 by the WLA Web Administration Committee