Library Services Technology Grant Publication Application

October 6, 2009 in Forms

In order to apply you may download the form via the link below, or use the online form.

Library Services Technology Grant Downloadable Form in PDF format (right click and choose save as)

All fields marked with a * are required:

Name*
Address
City
State or Province
Zip
Phone Number*
Fax Number
Email*
Type of Work Choose Published, Unpublished or leave blank
Book
Poetry
Article or other written work
Description
Release Agreement*

to allow the Library Services Technology Grant and its partners to display or use images of myself and my creations. Click here for full details of the release agreement.

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This project made possible through a Library Services Technology Act grant to
the Missouri Department of Mental Health administered by the Missouri State Library.
Materials on this site developed by the Missouri Institute of Mental Health .