Library At Home Facility Interest Form

Facility Name*

Primary Contact Person*

First NameLast Name

Primary Contact Person's Job Title*

Primary Contact Person's Email Address*

example@example.com

Secondary Contact Person*

First NameLast Name

Secondary Contact Person's Job Title*

Secondary Contact Person's Email Address

example@example.com

Census at your Facility

Approximate number of total residents

Facility Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Alternate Phone Number

Please enter a valid phone number.

General Facility Email (if available)

example@example.com

Which communication method do you prefer?

Type of facility (select all that apply)

Type of monthly services requested* (check all that apply)

A Library at Home specialist will visit your facility at the same week and time each month (eg: Third Mondays at 10AM). We will discuss this schedule with you during our initial consultation. What days or times work best for your activity schedule?

What else should we know about working with you and your facility or community? Do your residents have any specific areas of interest we should know about? What questions do you have for our Specialists?

Library at Home works in partnership with your facility to bring your residents the best service possible. By requesting library service, you agree that you will:

Help promote the library's services to your residents by including Library at Home visits on your facility's activity calendar, announcing our visits, or notifying residents in other ways.
Notify us if the contact person for your facility changes or if circumstances arise that would impact our ability to serve your community.
Be available to communicate with a Library at Home specialist upon registration, at annual check-ins, and as questions arise
Provide the necessary space for any ACPL rotating collection
Provide a time and space for any scheduled monthly program or pop-up library
Work with a Library at Home specialist to determine the best ways to meet the needs of your facility and your residents
Be willing to assist Library at Home staff with material drop-offs, returns, or patron communication in extenuating circumstances (lockdown, resident transitions, etc).

Please note that service is subject to availability and scheduling, and your facility may be placed on a waiting list. By submitting this form you authorize ACPL staff to create a new library account for your organization to be managed solely by Library at Home personnel for the purpose of delivery services only.

Library At Home Facility Interest Form

Library Service Preferences

Library at Home Service Agreement