Please review all information at www.ala.org/aasl/disasterrelief
prior to filling out the application.

Grant Application

PART I: PROFILE

1. School Data
School Name  
        Address
                     
              City    State     Zip Code

Telephone Number - -
          Fax Number  - -

Email  
Web Site
Principal
School librarian
Grade Level(s)  
Current Enrollment
Displaced/evacuee Enrollment, if applicable
Public school   Yes No
NCES ID
School District Name
School District Address
                                    
                             City    State     Zip Code

2. Applicant (primary contact)
Name  
Title
Address
             
      City    State     Zip Code

Telephone Number  - -     Ext
          Fax Number  - -
 
        Email Address  
Position    - Choose One - Certified School librarian Certified teacher Principal Library support staff Volunteer Other If Other

(select all that apply)
ALA member  
AASL member  
NEA member

3. Grant Coordinator (If different from above)
Name
Title
Address
             
      City    State     Zip Code

Telephone Number  - -    Ext
          Fax Number  - -
 
Email Address
Position    - Choose One - Certified School librarian Certified teacher Principal Library support staff Volunteer Other If other, please specify

(select all that apply)
ALA member  
AASL member  
NEA member 

4. If neither the applicant nor the grant coordinator is a certified school librarian, please identify the certified school librarian who will be assisting with collection development.
Name
Title
Address
             
      City    State     Zip Code

Telephone Number  - -    Ext
          Fax Number  - -
 
Email Address
Position    - Choose One - Certified School librarian

(select all that apply)
ALA member  
AASL member  
NEA member 

5. Grant recipients must be within 20 miles of a Dollar General store, distribution center or corporate office.
Please identify the closest Dollar General facility.  Dollar General Locator
Address
      City    State     Zip Code
Distance from school miles

6. Type of Disaster 
- Choose One - EarthQuake Hurricane Flood Avalanche Mudslide Fire Act of Terrorism Other If other, please specify
Date of Disaster

7. Grant (Up to $15000) Amount Requested

8.How did you learn about Beyond Words: the Dollar General school library relief fund?
(Check all that apply.)
Professional journal, please specify
ALA/AASL Web site
NEA Web site
Dollar General Web site
Dollar General store
Online discussion group, please specify
Building or district administrator
Other, please specify