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CIPA COMPLIANCE CERTIFICATION FORM <br />for Public Libraries <br /> <br />As the authorized library representative, I hereby certify that the library is <br />(check only one of the following boxes) <br /> <br />A. CIPA Compliant <br />The applicant library has complied with the requirements of Section 9134(f)(1) of the Library <br />Services and Technology Act. <br /> <br /> <br />OR <br /> <br /> <br />B. The CIPA requirements do not apply because no funds made available under the LSTA program <br />will be used to purchase electronic equipment capable of accessing the Internet or to pay for <br />direct costs associated with accessing the Internet. <br /> <br /> <br /> <br /> <br /> <br />Fnfsz!Psuj{ <br /> <br />Printed name of library director <br /> <br /> <br />Signature of library director <br /> <br /> <br />Date <br />CIPA Compliance Certification Form <br />State Library of North Carolina <br /> <br />