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2022 Nomination Form

National Medal for Museum and Library Service

OMB CONTROL NUMBER: 3137-0097, EXPIRATION DATE: 06/30/2024

(To be completed by the nominated organization)

Section A.

1. Nominated Organization
If your organization is not eligible on its own, then enter the name and address of the eligible entity under “Legal Name.” For example, if your organization is a library that is part of a university, list the university under “Legal Name” and the library under “Organizational Unit.”
2. Nominated Organization Address
Nominated Organization Address
3. Nominated Organization Telephone Number
4. Nominated Organization Web Address
(example: https://www.imls.gov)
5. Nominated Organization's Director/CEO