Quarterly Grant Request Form

The primary objective of the Friends of the Library of Hawai‘i is to maintain free public libraries in the State of Hawai‘i, to promote extension of library services throughout the State of Hawai‘i, and to increase the facilities of the public library system of Hawai‘i by securing materials beyond the command of the ordinary library budget.

If you are interested in requesting funds for your public library branch you may fill out this online request form. You must also PRINT the form and send it to the FLH office with the necessary signatures.

A. Contact Information
Library/Branch/Section *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Request Made By: * First Last
Request Date * / MM / DD YYYY
Work Phone * - ### - ### ####
B. Request Information
Clearly state the purpose for the request and how your request will benefit your library and/or patrons: *

You may submit an additional letter if the space provided is not adequate.
Have you submitted a similar request to the State? *
Yes No
If "No", why not? or if "Yes", why was funding not provided? Explain below: *
If you have a local Friends group, have they been approached for the request? *
Yes No No Local Friends
If "No", why not? If "Yes", why did they not provide full or partial coverage? Explain below: *

If "No Local Friends" please write "No Local Friends."
Provide a complete description of materials/equipment to be purchased, if any (include size, model #, color, etc.): *

You may submit an additional letter or budget if the space provided is not adequate.
Source of materials/products (include name of company and/or person, address, and phone number): *

You may submit an additional letter if the space provided is not adequate.
Provide a brief description of the program/project (include name(s) of person(s) who will be receiving compensation for their participation): *
Date Funds Needed * / MM / DD YYYY
Date of Program/Project
If Different from the Date Above / MM / DD YYYY
Total Cost of Materials (Including shipping, handling, assembly, etc.) * $ . Dollars Cents
Total Cost of Program (Include compensation, travel, honoraria, etc.) * $ . Dollars Cents
Total Cost (Add lines above) * $ . Dollars Cents
Total Amount Requested from Friends of the Library of Hawai‘i * $ . Dollars Cents
STOP

BEFORE clicking "Continue", please PRINT a copy of this form and collect the required signatures. Then mail/email/forward the form to:

admin@flhhawaii.org
or

Attn: Quarterly Grant
Friends of the Library of Hawai‘i
501 Sumner Street, Unit 614
Honolulu, HI 96817
Branch Librarian Signature
Date
PLB, HSL, or LBPD Director Signature
Date
State Librarian's Signature
Date
FLH Executive Director's Approval
Date
Type the letters you see in the image below.

Quarterly Grant Request Form

Quarterly Grant Request Form

A. Contact Information

B. Request Information

STOP BEFORE clicking "Continue", please PRINT a copy of this form and collect the required signatures. Then mail/email/forward the form to: admin@flhhawaii.org or Attn: Quarterly Grant Friends of the Library of Hawai‘i 501 Sumner Street, Unit 614 Honolulu, HI 96817

Branch Librarian Signature

Date

PLB, HSL, or LBPD Director Signature

Date

State Librarian's Signature

Date

FLH Executive Director's Approval

Date

STOP

BEFORE clicking "Continue", please PRINT a copy of this form and collect the required signatures. Then mail/email/forward the form to:

admin@flhhawaii.org
or

Attn: Quarterly Grant
Friends of the Library of Hawai‘i
501 Sumner Street, Unit 614
Honolulu, HI 96817