Agency Name
|
Contact Person
|
Address
|
City
|
State
|
ZIP+4
-
|
Telephone Number
(
)
-
|
Extension
|
Message Number
(
)
-
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Email
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Type of Agency
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If Other, please describe:
|
Types
of Service Requested
Books on Tape - Includes one 4-track
tape player
Magazines on Tape - List of options will be mailed to you
|
Reader Profile - Check
what applies to those who will be using the service
|
Books should be in: |
|
| If other, please describe: |
|
Restrictions: (Please Select)
No explicit
descriptions of violence
No explicit descriptions
of sex
No strong language
|
Reading Level: (Please select)
Juvenile
Young Adult
Adult |
If Juvenile, please check all
that apply: |
P-3
2-6
4-7
5-9 |
| Please send us books from the
following subject areas: |
Subjects: |
Adventure - Fiction ADV
Adventure - Non-Fiction ADVM
Animals - Fiction ANM
Animals - Non-fiction ZOO
Arizona - Fiction AZIH, AZIM, AZIW
Arizona - Non-Fiction AZNF, AZNFH, AZNFT
Arts and Crafts AC
Autobiography ABI
Best Sellers - Fiction BEF
Best Sellers - Non-Fiction BEN
Biography BIO
Books in Spanish SPL
Classics CLA
Family Stories FSTD
Fantasy Fiction FAN, SCFAN
Gentle/Nostalgic Fiction GENT
Historical Fiction HIF
Historical Fiction, U.S. Only HIFUS |
History HST
History - U.S. Only HUS
Horror Stories HOR
Humor HUM, MYSH, TRAH
Mysteries MYS, MYSA, MYSB
Nature - Non-fiction NAT
The Occult OCC, OCCN
Poetry POE
Psychology, Popular PSY
Religion REL
Romance ROM
Science Fiction SCF, SCFAN
Short Stories SST
Social Issues SOPP
Sports SPO
Travel TRA
Travel U. S. Only TRAUS
Westerns WES |
Library may select books for this account from
the subject areas marked above.
Send only books that we order
(at least 4 books per year to retain equipment.)
|
Authorization Signature |
| I certify that this agency regularly
provides service to individuals who are unable to read a regular
print book because of a permanent or temporary visual or physical
disability. I hereby request an institutional account with the Arizona
State Braille and Talking Book Library in order to provide these
individuals with the opportunity to enjoy recorded materials. |
| |
|
ADMINISTRATOR'S Signature
___________________________________
|
Date
___________________________________
|
Printed Name
___________________________________
|
Title
___________________________________
|
Phone
___________________________________
|
| |
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Mail the completed application
and certification form to:
Arizona State Braille And Talking
Book Library
1030 N. 32nd Street
Phoenix, Arizona 85008
Attn: Christine Tuttle
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