Application Form For Free Library Service - Adults Page 4
Download a blank fillable Application Form For Free Library Service - Adults in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application Form For Free Library Service - Adults with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5Print Form
Certification
To Be Completed by the Certifying Authority. Please refer to the information on page 5 (items B
and C) concerning who may certify.
“I certify that _______________________ (applicant) has requested library service and is
unable to read or use standard printed material for the reason indicated on this application.”
Please print or type:
Certifier’s Name: __________________________________________
Date: _____________
Title: ___________________________________ Occupation: ____________________________
Place of Employment/Affiliation: ___________________________
Telephone: ______________
Address: ________________________________________________________________________
City: ___________________________________
State: _____ Zip: ____________________
E-mail: ________________________________________________________________________
Signature (Original): _____________________________________________________________
If you have printed out this form, please have it signed by the certifying authority, and
mail it to:
New York State Talking Book and Braille Library
Cultural Education Center
222 Madison Avenue
Albany, NY 12230-0001
If you are submitting the form electronically, please use the e-mail or fax number below. For
any questions about the form, please call or e-mail TBBL.
Phone: (800) 342-3688
Fax: (518) 474-7041
E-mail:
tbbl@nysed.gov
Website:
The New York State Talking Book and Braille Library is a service of the NY State Library, NY State
Education Department, and the National Library Service for the Blind and Physically Handicapped,
Library of Congress, Washington DC.
4
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application Form For Free And Reduced-price School Meals - Oklahoma State Department Of Education Eligibility Documentation
Legal
Fdacs-03320 Application Form For Registration Of Service Agencies - Florida Department Of Agriculture And Consumer Services, Division Of Consumer Services, Bureau Of Standards
Legal
Da Form 3433-2 - Supplemental -a Employment Application Form For Child-youth Services Positions
Business
Da Form 3433-2 - Supplemental-a Employment Application Form For Child-youth Services Positions
Business
Related Categories
Parent category: Life