Please complete the form below to apply for the Library’s Home Borrow Service. Our Home Borrow Coordinator will contact you with more information about the program and to discuss your reading preferences.
Full Name (required)
Facility Name - if applicable
Room Number
Address (required)
City (required)
State (required)
Zip Code (required)
Phone - daytime (required)
Phone - evening
Date of Birth
Gender —Please choose an option—MaleFemalePrefer not to answer
Name of contact person (required)
Phone number of contact person (required)
Primary reason for needing the service (required) —Please choose an option—ElderlyPhysically ImpairedInjuredCritically IllLong-term Care FacilityRetirement CenterRehab CenterHomebound StudentOther
Do you have a library card? (required) —Please choose an option—YesNo
Do you have a computer or device with internet access? (required) —Please choose an option—YesNo
Will you need large print materials? (required) —Please choose an option—YesNo
Do you have a hearing impairment? (required) —Please choose an option—YesNo
Δ