FY 2019 Community Collaboration Grant Application 

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Library Legacy Logos

Fields with an asterisk (*) are required.

Community Collaboration Grant Applicant

Applicants MUST be a SELCO member to qualify for Community Collaborations grant funds.

As part of the Legacy Amendment requirements, the applicant and organizational information will be posted on the State of Minnesota's public Legacy webpage.










Project Details



Project Program/Event
If there are multiple public program/event, you must list every date.  For example, if the same musician performs 4 different times, each must be listed as its own activity/event.

If there are any changes, additions, or cancellations of dates, you must notify SELCO prior to the change.

This includes title and a short description of the activity/event.










Partnership

SELCO requires the involvement of at least one community partner for the successful completion of a Community Collaboration application and project.


Any organization, group or individual donating time, money or effort to your grant project must be listed as a partner. Each partner must submit a letter of support acknowledging awareness of this application and confirming any pledges of support stated within. Letters of support are due concurrent with your application materials.  

Electronic copies may be submitted to legacy@selco.info.

Partner



What is your partner supplying in this? Space? Advertising? Money?
SELCO use only


Page 3

Budget

The limit for Community Collaboration projects is $7,000 per library per grant.

If your project is for more than $7,000 please contact the SELCO Legacy Project Coordinator at legacy@selco.info before submitting your application.


Please round amounts up to nearest dollar.  ($135.03 becomes $136)


This form is now able to do auto-fill and auto-calculations.  Please, still double-check your numbers!

Grant Request Budget
Amount Requested
a. Contracted Services (artist payment, travel, hotel) *W-9 required
$
b. Advertising/Marketing
$
c. Technology/equipment
$
d. Materials (consumables)
$
Expenses for consumables used in the course of the program, exhibit or project. The applicant or partners cannot claim expenses for prizes or incentives, including refreshments.
e. Evaluation
$
Expenses related directly to measuring outcomes used in the final report.
f. Miscellaneous (include description below)
$
No food or beverages
SUB-TOTAL
$
g. Collection (10% max of the subtotal)
$
TOTAL
$
*If SELCO is paying these expenses directly to the performer, speaker, etc., they must fill out a W-9 form to be returned to SELCO.
Grant Request Budget Narrative









In-Kind Contributions-Member Library


In-Kind expenses are those that will not be paid for from Legacy funding.  While they may include monetary contributions, other services and resources should be included as well.  These may include the amount discounted by a vendor, the estimated cost of renting a location that has been donated, and the amount of staff time spent on creating and evaluating the program multiplied by wage.

In-Kind Amount
a. Personnel (coordination & development by member library and/or contracted services)
$
b. Advertising/marketing of program
$
c. Technology/equipment
$
d. Materials (consumables)
$
Expenses for consumables used in the course of the program, exhibit or project.
e. Evaluation
$
Expenses related directly to measuring outcomes used in the final report.
f. Miscellaneous (include description below)
$
g. Collection
$
TOTAL
$
In-Kind Narrative - Member Library







In-Kind Contributions-Partner


In-Kind expenses are those that will not be paid for from Legacy funding.  While they may include monetary contributions, other services and resources should be included as well.  These may include the amount discounted by a vendor, the estimated cost of renting a location that has been donated, and the amount of staff time spent on creating and evaluating the program multiplied by wage.

List each partner it its own In-Kind section.

In-Kind (Partner)
a. Personnel (coordination and development and/or contracted services)
$
b. Advertising/marketing of program
$
c. Technology/equipment
$
d. Materials (consumables)
$
Expenses for consumables used in the course of the program, exhibit or project.
e. Evaluation
$
Expenses related directly to measuring outcomes used in the final report.
f. Miscellaneous (include description below)
$
g. Collection
$
TOTAL
$
In-Kind Narrative - Partner







Summary
Grant Request In-Kind Total Total
a. Contracted Services/In-Kind Personnel
$
$
Total of In-Kind from Library and all Partners.
$
b. Advertising/Marketing
$
$
$
c. Technology/Equipment
$
$
$
d. Materials
$
$
$
e. Evaluation
$
$
$
f. Miscellaneous
$
$
$
g. Collection
$
$
$
TOTAL
$
$
$
SELCO use only

Page 4

 Community Collaboration Grant Assurances



Article IV









Submission Date

The date the Submit button is pressed.