Please review all information at www.ala.org/aasl/disasterrelief <http://www.ala.

org/aasl/disasterrelief> prior to filling out the application. *Grant Application* PART I: PROFILE *1. School Data * School Name School Address School Address 2 City State Zip Code Telephone Number Phone number prefix- Phone number suffixFax Number Phone number prefix- Phone number suffixEmail Enter a valid email address Web Site Principal School librarian Grade Level(s) Current Enrollment Displaced/evacuee Enrollment, if applicable Public school YesNo NCES ID School District Name School District Address Address 2 City State Zip Code *2. Applicant (primary contact) * Name Title Address School Address 2 City State Zip Code Telephone Number Phone number prefix- Phone number suffix- Ext Fax Number Phone number prefix- Phone number suffixEmail Address You must enter a valid email address * Position If other (select all that apply) ALA member AASL member NEA member *3. Grant Coordinator (If different from above) * Name Title Address Address 2 City State Zip Code

Telephone Number Phone number prefix- Phone number suffix- Ext Fax Number Phone number prefix- Phone number suffixEmail Address Position If other (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 Address2 City State Zip Code Telephone Number Phone number prefix- Phone number suffix- Ext Fax Number Phone number prefix- Phone number suffixEmail Address Position (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 <http://www.dollargeneral.com/storeLocator/index.jsp> Address City State Zip Code Distance from school miles *6. Type of Disaster * Type If other Date of Disaster *7. Grant (Up to $20,000) * 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 PART II: YOUR NEEDS AND YOUR REQUEST

The purpose is to provide relief to public school libraries that have incurred substantial damage or hardship (including the absorption of displaced/evacuee students) due to a natural disaster (tornado, earthquake, hurricane, flood, avalanche, mudslide, etc.), fire or an act recognized by the Federal Government as terrorism. The goal is to replace or supplement books, media, and/or library equipment that support learning in a school library environment. *9. Describe the impact of the disaster on the school library program. (Include the addition of displaced/evacuee students.)* Limited to 1400 characters: about 150 words *10. Describe the extent of loss or damage to the school library collection of books, media and equipment. * (Limited to 1400 characters: about 150 words) *11. How do you plan to use the funds to alleviate the disaster or hardship to the school library program and collection?* Limited to 1400 characters; about 150 words *12. Estimate the budget expenditures showing how the funds will be spent in the school library setting. * (limited to 1000 characters: about 100 words) *13. Describe any extenuating or unique circumstances that affect your school, community or library as a result of the disaster/hardship.* (limited to 1000 characters: about 100 words)

*14. Would you like to be considered for the catastrophic grant of $50,000?* YesNo *15. In order to qualify for a catastrophic award you must be able to offer documentation of a 90% or greater loss to your school library resources- can you document a 90% or greater loss? * YesNo *16. Please expand on your previous narrative to describe the impact a $50,000 grant would have on your school library program, the students, faculty and community.* (limited to 3000 characters: about 500 words)

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Part III: STATEMENT OF ASSURANCE * I, , principal of the , hereby certify the accuracy of the information provided in the application. Further, I fully support the submission of this application to Beyond Words: the Dollar General school library relief fund to support the school library and the project described therein. Further, I certify that funds granted by Beyond Words will not be used to supplant (replace) money normally budgeted for the school library program. I understand that these funds are to be used for the purposes in the application. I also agree to have the information we have submitted included as part of aggregated, unanimous data used for research purposes. If our school is funded, we agree to participate in publicity to promote the goals of the Program and to report on the use of the funds within one year. Date Only this online application will be accepted. No faxed, emailed or print forms will be accepted. Look over your application carefully before submitting. We recommend you save your content information in your own Word file before submission.

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