In-Home Library Service Application - Rochester Public Library

Applicant Information

Applicant Name *

Address *

Country

City

Zip code

Phone *

Birth year *

Email (if available)

Alternate Contact

Alternate Contact Phone

Eligibility

To be eligible for in-home library service, applicants must:

Reside in Monroe County
Have an illness or disability that prevents them from being able to visit the library
Read and agree to the program guidelines

In-home library service guidelines

Applicant Certification *

I certify that I meet all eligibility requirements listed above and have read the in-home library service guidelines. I understand that decisions concerning eligibility are determined on a case-by-case basis and physician certification may be required.

Date of Certification *

Library Material Preferences

Please check one of the following options: *

Bring only items I request

Choose items for me based on my preferences below

What types of library materials would you like delivered (check all that apply): *

Print books

Audiobooks (CD & Playaway formats available)

DVDs

Print book preferences: *

Regular print

Large print

Regular print if large print isn't available

How many items would you like at a time (you will get a delivery every 6-8 weeks): *

Favorite books and/or authors: *

Other preferences:

Captcha *

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Applicant Information

Eligibility

To be eligible for in-home library service, applicants must:

Library Material Preferences

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