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Application for Home Library Services
Click here for printer friendly version.

If you are interested in taking part in the services we offer to the homebound patrons in our district, please fill out this entire application and press the submit button. This form is not secure. If you wish, you may print the form instead and fax it to the library at (269) 324-9222 or send it to: Portage District Library Outreach Coordinator, 300 Library Ln, Portage, MI 49002.The Outreach Coordinator will contact you within five business days of receiving your completed form.

Name of Applicant
Street Address
City
Zip Code
Phone #
E-mail Address
*not required
Alternate Contact
Alternate's Phone #

Materials Available
Choose as many formats as you want.

Books Music Talking Books/CD Large Print Talking Book/Tape Information Services

Reading Interests
Fiction

Choose as many genres as you want.


Adventure Animal Best Seller Christian Classic Family Fantasy Gothic Historical

Horror Humor Medical Mystery Nature Romance Science Fiction Sea Short Story


Southern Sports Spy Suspense Thriller War Western

Reading Interests
Non-Fiction

Choose as many subjects as you want.

Adventure Animal Art Best Seller Biography Business Computers Cooking Crafts


Essays Handicaps Health History Humor Inspirational Foreign Language Music


Nature Philosophy Plays Poetry Psychology Religion Science Self-Help Sports


Travel War


All information in your library record is confidential.
Portage District Library is prohibited by law from revealing any personally identifying information.

    What's this?

Below are two choices for printer friendly versions of this form. If you choose to use the PDF, you will need to have a copy of Adobe® Reader 6.0. or equivalent. The library is not responsible for any computer support relating to this download.

 

 

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