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2021 Nomination Form

National Medal for Museum and Library Service

(To be completed by the nominated organization.)

Section A
1. Nominated Organization
3. Nominated Organization Telephone Number
4. Nominated Organization Web Address
5. Nominated Organization’s Director/CEO
6. Person Completing This Form
7. Type of Organization
8. Governing Control
9. Nominated Organization’s D-U-N-S® Number
Verify that your organization has a D-U-N-S® Number or take steps to obtain one. Your organization can receive a D-U-N-S® Number at no cost by calling the dedicated toll-free D-U-N-S® Number request line at 1 866-705-5711 or by visiting www.dnb.com/us.
10. Nominated Organization’s Employer/Taxpayer Number (EIN/TIN)
11. Congressional District of Nominated Organization
Congressional Districts can be found by entering the ZIP Code of the organization at http://www.house.gov/representatives/find.
12. Nominated Organization’s Annual Operating Budget
13. Nominated Organization’s Financial Information
Most recently completed fiscal year (FY)
For nonprofit tax filers Total Revenue can be found on line 12 of the IRS Form 990.
For nonprofit tax filers Total Expenses can be found on line 18 of the IRS Form 990.
Second most recently completed fiscal year (FY)
For nonprofit tax filers Total Revenue can be found on line 12 of the IRS Form 990.
For nonprofit tax filers Total Expenses can be found on line 18 of the IRS Form 990.
14. Audits and Material Weaknesses
(A material weakness is a deficiency, or combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity’s financial statements will not be prevented or detected and corrected on a timely basis.)
15. Staff
16. Total Number of Days Open
17. Nominator
Section B. Overview
In 400 to 550 words (the equivalent of about one page):
  • Summarize the nominated organization’s mission or statement of purpose.
  • Provide a brief history of the nominated organization.
  • Explain why you believe the nominated organization deserves to win the National Medal for Museum and Library Service.
Section C. Narrative

The National Medals program recognizes outstanding libraries and museums of all types and sizes that deeply impact their communities by:

- fostering a lifelong passion for learning for all people, nourishing curiosity and imagination from early childhood through adulthood, for people of all abilities and needs;

- providing access to information through advancing digital capacity, focusing on digital inclusion and access to digital and informational resources, including e-books and materials to help address workforce development and public health;

- transforming the lives of community members by being trusted community spaces for convening, connection, and conversation; enlightenment and shared thoughts and opinions; and preserving natural and cultural heritage and community memory;

- continuing to engage their communities during the unprecedented coronavirus pandemic and enhanced focus on diversity, equity, and inclusion, through providing information, programming, and services virtually, or taking innovative and imaginative steps toward continuing services and reopening their physical spaces.

Please respond to the following four sets of prompts from the point of view of the nominated organization in 1800 to 2500 words (the equivalent of about four pages).

1. Community and Community Needs

  • Describe your community, including its demographics.

  • Describe the community’s major needs and how you identified them.

  • In what ways does your staff work with the community?

Note: Academic and research libraries may interpret “community” as your campus community and/or local community.

2. Programs and Services

  • Referring to the community and its major needs you identified in Section C.1, describe the specific programs and services that have been developed to address one or more of those needs.

  • Provide a brief description of your full portfolio of programs and services as context for those described above.

  • How have you constructed community partnerships to increase your ability to connect with targeted population groups within your community?

  • Describe how you serve community members of all abilities.

Note: Organizations identified as Digital Libraries should address:

  • services to your community including services to other organizations and services to end users;

  • how an understanding of audiences, either current or potential, has driven the approach to providing access to your organization's programs and resources;

  • sustainability and preservation plans for the digital library; and

  • accessibility for people with disabilities, including persons with print disabilities.

3. Impact

  • Describe the impact of your organization’s programs and services on the identified community needs. Be specific, using qualitative, quantitative, or both types of descriptors as appropriate.

  • How does your organization track the cumulative impact of its programs and services through time?

  • How has your organization used these data to inform continuing and/or new programs and services?

4. Financial Sustainability

  • List your organization’s three primary sources of revenue.

  • Describe how your organization financially supports the programs and services discussed above. Does your organization have a sustainable funding model that will continue to enable these programs and services?

  • Identify any private or non-profit groups that support your organization’s mission and activities and describe the extent of their support.

Section D. Letters of Support
  • These letters should come from community members who have direct knowledge of the nominated organization’s community service and the particular programs identified in the nomination. We recommend that the letters come from different segments of the broader community served by the organizations and from individuals who have either witnessed or experienced first-hand a particular program or service.
  • In addition to the three letters of support, letters from members of Congress are welcome. They may be uploaded with your nomination form or emailed to nationalmedals@imls.gov.
  • Address letters to the Director of the Institute of Museum and Library Services and upload them with this Nomination Form or email them to nationalmedals@imls.gov.
Files must be less than 10 MB.
Allowed file types: txt pdf doc docx png jpeg bmp.
Files must be less than 10 MB.
Allowed file types: txt pdf doc docx png jpeg bmp.
Files must be less than 10 MB.
Allowed file types: txt pdf doc docx png jpeg bmp.
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