HomeWord Bound

Qualification for HomeWord Bound Service

  I am a resident of Deschutes County, Oregon

At least one of these must apply:

  Short-term disability
  Long-term disability
  Illness which confines individual to their home
  75 years or older

If you qualify for HomeWord Bound services, please provide the following contact information :
 Name  
Mailing Address  
City, State, Zip  
Physical Address (if different)  
Home Phone (so library staff can contact you)  
Best day and time to call you  
E-mail  
Gender  
Birth date  
Do you reside in a residential care facility or an apartment complex?  
If "yes," facility name  

 

 Name of person helping fill out this form  
Should library staff contact the person helping to
fill out this form about applicant's reading preferences?
 
If yes, phone number  





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Last modified on Monday, August 08, 2011