Agency Name
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Contact Person
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Address
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City
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State
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ZIP+4
-
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Telephone Number
(
)
-
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Extension
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Contact's Email
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Type of Agency
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If Other, please describe:
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Types
of Service Requested
Books on Digital Cartridge - Includes one one Standard Digital Player
Magazines on Digital Cartridge - Magazines List will be mailed to you
BARD (Braille and Audio Recording Download)
Braille Web-Braille
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Reader Profile - Check
what applies to those who will be using the service
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Books should be in: |
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| If other, please describe: |
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Restrictions: (Please Select)
No explicit
descriptions of violence
No explicit descriptions
of sex
No strong language
|
Reading Level: (Please select)
Juvenile (Check all that apply)
P-3 2-6 4-7 5-9
Young Adult
Adult
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| Please send us books from the
following subject areas: |
Subjects: |
Adventure - Fiction ADV
Adventure - Non-Fiction ADVN
Animals - Fiction ANM
Animals - Non-fiction ZOO
Arizona - Fiction AZIH, AZIM, AZIW
Arizona - Non-Fiction AZNF, AZNFH, AZNFT
Autobiography ABI
Best Sellers - Fiction BEF
Best Sellers - Non-Fiction BEN
Biography BIO
Books in Spanish SPL
Classics CLA
Current Events CUR
Family Stories FAM
Fantasy Fiction FAN
Folktales, Myths, Fairytales FOL
Gentle/Nostalgic Fiction GENT
Historical Fiction (World) HIF, HIFF
Historical Fiction (U.S.) HIFUS, PIO |
History HST
History (U.S.) HUS
Horror Stories HOR
Humor HUMF, HUMNF
Music MUS, ABIM, BIM
Mysteries MYS, MYSA, MYSB
Nature - Non-fiction NAT
Paranormal fiction PARA
Poetry POE
Religion (Nonfiction) REL, BIB, CHNF; LDS
Religion (fiction) CHF; CHFA
Romance ROM, ROP, ROMSU
Science Fiction SCF
Short Stories SST
Sports SPO, ABIS, BIS, SPB, SPK, SPF
Suspense/Thriller SUS, ROMSU
Travel (World) TRA, TRAH
Travel (U.S.) 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. |
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ADMINISTRATOR'S Signature
(Other than Contact Person)
___________________________________
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Date
___________________________________
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Printed Name
___________________________________
|
Title
___________________________________
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Phone
___________________________________
|
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Mail the completed application
and certification form to:
Arizona Talking
Book Library
1030 N. 32nd Street
Phoenix, Arizona 85008
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