Application for Certificate of Public Librarianship

Please fill out this form to apply for the Department's Certificate of Public Librarianship program.

First Name *

Middle Initial

Last Name *

Email Address *

Telephone *

Are you currently enrolled in the certification program *

Yes

No

Not Sure

Home Address:

Street Address *

City *

State *

Zip Code *

Library Information (if applicable):

Library

Address

City

State

Zip Code