LSTA PARTNER STATEMENT In order for the library to qualify for a 10% match, partners must contribute a deliverable to the project. Complete one form for each partner. 1. Library Name 2. Grant Category 3. Partner Organization (name, address, phone) 4. Partner Contribution This may be a cash amount or in-kind contribution such as donated personnel, training space, transportation, supplies, materials, printing, or other items to be used in implementing the project. Specify the expected quantity, frequency, etc. such as for 2 one hour classes each month, “the partner will provide an instructor totaling 20 classes over 10 months.” 5. Partner Roles/Responsibilities The undersigned partner organization agrees to carry out the activities described in numbers 4 and 5 above. Name and Title of Partner Organization Representative Signature of Partner Organization Representative Date
LSTA PARTNER STATEMENT In order for the library to qualify for a 10% match, partners must contribute a deliverable to the project. Complete one form for each partner. 1. Library Name 2. Grant Category 3. Partner Organization (name, address, phone) 4. Partner Contribution This may be a cash amount or in-kind contribution such as donated personnel, training space, transportation, supplies, materials, printing, or other items to be used in implementing the project. Specify the expected quantity, frequency, etc. such as “the partner will provide an instructor for 2 one hour classes each month, totaling 20 classes over 10 months.” 5. Partner Roles/Responsibilities The undersigned partner organization agrees to carry out the activities described in numbers 4 and 5 above. Name and Title of Partner Organization Representative Signature of Partner Organization Representative Date