1 Application Details2 Library Information3 Equipment Request4 Sign & Submit Blackfoot's Public Library Grant Program focuses on purchasing electronic equipment for public use at County public libraries located within our service territories. To apply for a Library Grant, please complete this online application. Be sure to explain how the equipment will benefit your library. You may also attach additional information including pricing, a description, and/or images of the requested equipment. Blackfoot will donate a minimum of $1,000 per library, for libraries located within Blackfoot's service territories. Each library may submit ONE application. Not all libraries will receive funds. Application deadline: March 1, 2018 For questions, please contact program administrator Marilee Klaudt at email@example.com or 406-541-5111. Library InformationLibrary Name*Your Name (Person Completing Application)*Job Title*What county is the Public Library located in?*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Library Phone Number*Email* Is the library a Blackfoot customer?*YesNoWhat is your Blackfoot account number?* Request for Equipment FundingWhat is the piece of equipment?*What is the price?*How will the equipment be used?*Optional: Please upload any additional information about the equipment. Application SubmissionBy submitting this application, you agree that any grant award shall be used for the sole purpose of purchasing electronic equipment for use at the public library. Electronic Signature*Please fill in your name below to electronically sign your application. By doing so, you are acknowledging that you are a representative of the library, and that all information entered on the form is accurate to the best of your knowledge.Date* This iframe contains the logic required to handle Ajax powered Gravity Forms.