APPLICATION
 
                     1994 ANNUAL CONFERENCE SCHOLARSHIP
                MIDWEST CHAPTER/MEDICAL LIBRARY ASSOCIATION
 
MC/MLA is offering up to four scholarships to assist entry-level
health sciences librarians with expenses of attending the MC/MLA 1994
Annual Conference in Rockford, Illinois, October 9-12.  No award will
exceed $300.  Applicants must have an MLS degree, must have been
actively employed as professional health sciences librarians for
no more than three years, and be residents of or employed in
North Dakota, Minnesota, Iowa, Wisconsin, Illinois, Michigan, Indiana,
Kentucky, or Ohio.  Awardees will be required to submit an article to
MIDLINE describing their conference experiences before reimbursement
will be made.
 
Name __________________________________________________________________
 
Mailing Address ________________________________________________________
________________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
 
Phone __________
Electronic Mail Address ______________________________________
 
Place of Employment __________________________________________
 
Position ____________________________________________ How Long?_______
 
Other Health Sciences Librarian Positions            Dates
 
_______________________________________________   ________________
 
_______________________________________________   ________________
 
 
Year MLS Received____________ School ______________________________
 
Below, Please estimate and itemize anticipated expenses of attending
the Annual Conference.  Include travel, lodging, registration fee,
Continuing Education course fee, if applicable.  Indicate the means
of travel and the number of nights of lodging needed.  Information
about the meeting is available from Nancy Dale (815-961-2030, x4556) or
Phyllis Nathan (815-961-6287).
 
_____________________________________________________________________
 
_____________________________________________________________________
 
_____________________________________________________________________
 
What is the most you could contribute to these expenses?_____________
 
_____________________________________________________________________
 
Will you receive any institutional funding? ______
If yes, how much? ________________________________
 
Signature _______________________________________ Date ____________
 
Please attach the following items to your application:
 
 Resume including work experience, awards, honors, memberships,
   special skills, licensures, certifications, etc.
 
 Cover letter explaining what you hope to gain from attending the
   Annual Conference.
 
RETURN PACKET BY SEPTEMBER 7, 1994, TO:
   Monica Unger, Ocasek Regional Medical Information Center,
   Northeastern Ohio Universities College of Medicine, P.O. Box 95,
   Rootstown, OH  44272-0095, ((216) 325-2511, ext. 539).
 
Applications may be sent by FAX to: Monica Unger at (216) 325-0522.