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Request For Outreach or Home Services

  1. 1. Nature of request: Example-Monthly book delivery, book selection for pick up by relatives, etc. 2. Reason for Request and/or anticipated duration of request: Example-I broke my leg and will need services for three months. 3. Is there a mobile person in the same home with whom the Library could work to arrange material pickup?
  2. Interests: Please check all that apply
  3. Interests: Please check all that apply
    Non fiction
  4. Format: Books in regular print/Large Print Books/Books on CD
    Book Bags are shipped once a month; with a capacity of 3-5 items depending on size.
  5. (Library use only) Staff Initials
  6. Leave This Blank:

  7. This field is not part of the form submission.