Community Outreach Application

"*" indicates required fields

I am applying for...*
Client Name*
MM slash DD slash YYYY
Library Card Status*
14-digit number starting with 25320
Caretaker Name (If Applicable)
Address*
Address where services will be delivered to client.

Contact Information

Contact information for the client or caretaker who will be communicating with Outreach Services.
Name by which the person being contacted wishes to be addressed.
Preferred Contact Method*
Phone Type
Agreement*
I agree to observe all rules established by the library and will be responsible for ALL materials borrowed on my card. I also agree to pay any fines or other charges imposed for late return of or damage to any library materials. I understand that all of the above information will be confidential.

Interests & Preferences

What types of books, materials, and activities are you interested in receiving from Outreach Services?
Select the number of new items you would like with each delivery.
Print Size
Please bring me large print materials ONLY
Subjects & Genres
Material Types
Fun Stuff