# Network Library of the Year Nomination

## Instructions

Fill out the form, print it and get required endorsements and
signatures. Then fax or mail according to the instructions below.

### Nominee

Complete this portion for the library you are nominating.

  ------------------ ----------------------------------------------------
  Library name:      

  Name of director:  

  Library Address:   

  City, State, ZIP:  

  Phone:             

  Fax:               

  E-mail:            

  Administering      
  agency:            

  Number of users:   

  Number of Staff:   

  Annual budget, all 
  sources:           

  Additional         
  comments or        
  explanations:      
  ------------------ ----------------------------------------------------

+-----------------+----------------------------------------------------+
| ### Nominator   |                                                    |
|                 |                                                    |
| Complete this   |                                                    |
| portion to tell |                                                    |
| us about        |                                                    |
| yourself.       |                                                    |
+-----------------+----------------------------------------------------+
| Name:           |                                                    |
+-----------------+----------------------------------------------------+
| Title:          |                                                    |
+-----------------+----------------------------------------------------+
| Organization:   |                                                    |
+-----------------+----------------------------------------------------+
| Preferred       |                                                    |
| address:        |                                                    |
+-----------------+----------------------------------------------------+
|                 |                                                    |
+-----------------+----------------------------------------------------+
|                 |                                                    |
+-----------------+----------------------------------------------------+
|                 |                                                    |
+-----------------+----------------------------------------------------+
| Phone:          |                                                    |
+-----------------+----------------------------------------------------+
| Fax:            |                                                    |
+-----------------+----------------------------------------------------+
| E-mail:         |                                                    |
+-----------------+----------------------------------------------------+
| Relationship to |                                                    |
| nominee         |                                                    |
| library:        |                                                    |
+-----------------+----------------------------------------------------+
| **Nomination    |                                                    |
| Statement** (To |                                                    |
| be considered   |                                                    |
| it is mandatory |                                                    |
| that nominators |                                                    |
| attach a        |                                                    |
| 250-word        |                                                    |
| double-spaced,  |                                                    |
| typewritten     |                                                    |
| page each       |                                                    |
| applicable      |                                                    |
| criterion.)     |                                                    |
|                 |                                                    |
| I believe the   |                                                    |
| nominee should  |                                                    |
| be Network      |                                                    |
| Library of the  |                                                    |
| Year for year   |                                                    |
| 2005 because-   |                                                    |
+-----------------+----------------------------------------------------+
| Signature:      |                                                    |
+-----------------+----------------------------------------------------+
| Date:           |                                                    |
+-----------------+----------------------------------------------------+

## Instructions

Deadlines: All nominations must be received no later than March 15,
2005. If a nominator does not receive confirmation of the nomination by
April 1, please contact Carolyn Sung by phone at (202) 707-9300 by
e-mail at csun@loc.gov. Send all nominations by expedited delivery
service to the National Library Service for the Blind and Physically
Handicapped (NLS/BPH), Library of Congress, 1291 Taylor Street NW,
Washington, DC 20542-4960 or fax them to (202) 707-1690. Selections will
be made in May 2005 and announced on June 1, 2005. For full details on
the award consult Network Bulletin 05-04, which is available from NLS or
at [www.loc.gov/nls/bulletins](http://www.loc.gov/nls/bulletins).