Please complete this Declaration of Intent to Enroll form if you have attended your first workshop for Minnesota Voluntary Certification Level I. This can be a CLIME or Certification Oversight Committee approved workshop or "What is Library Service?" Day 1 Workshop. You have four years from the date you attended your first workshop to complete Certification.

Today's Date:        
Your Name:        
Library Name:    

Your Library Address


Regional Library System:        
Library Phone (include area code):    
Library Fax (include area code):        
Job Title (Current Position):        


Home Address


Home Phone (include area code):    
E-mail address:    


I atteneded (name of workshop) on (date) .

I attended "What is Library Service, Day One" on (date)
at (location) .


I attended "What is Library Service, Day Two" on (date)
at (location) .


I understand that having my name on the State Certification Database means that it will ONLY be used on listservs and mailings pertaining to MN Voluntary Certification.


Please send a check for $10.00 enrollment fee to:
Arrowhead Library System
Rebecca Patton
5528 Emerald Avenue
Mountain Iron, MN 55768
Make check payable to the Arrowhead Library System and attach a post-it note that the check is for Certification.






Thanks! Your form is being sent to Rebecca Patton, who is compiling this database. She may be contacted by phone at 218.741.3840 or through e-mail at rpatton@arrowhead.lib.mn.us.



Return to Library Certification Home Page.