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Homebound Service Volunteer Form

Homebound Service
Community Outreach
Monroe County Public Library
303 E. Kirkwood Ave.
Bloomington, IN 47408
(812) 349-3050 ext. 2058

First Name: *

Last Name: *

Age: *

Address: *

City: *

Zip Code: *

Home Phone: *

Work Phone:

Email: *

Do you have your own vehicle? *

Yes

No

Do you have proof of insurance? *

Yes

No

How far in the county are you willing to drive to deliver to a library patron? *

Do you have a preference for a male or female patron? *

Male

Female

No preference

Do you have any experience in libraries or related work? *

Yes

No

What are your reading interests? *

Would you have time to select and deliver materials at least once a month? *

Yes

No

Can you volunteer for at least one year? *

Yes

No

Comments or additional information::

Background Check: (Please read carefully before submitting application.)

required: * I, (please type your name)

understand that my check in the box below authorizes Monroe County Public Library to conduct a background check in connection with this application.

Agreement: *

Check here

COMMUNITY OUTREACH
www.mcpl.info/outreach
812-349-3050, ext. 2058

Updated February 23, 2012

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Community Outreach

Bookmobile
Homebound
Jail Library Service
Outreach Van
VITAL - Volunteers in Tutoring Adult Learners

Homebound Service Application

Homebound Service Volunteer Form

Homebound Brochure (PDF)

Bookmobile Brochure (PDF)

Contact Outreach

Questions or comments about Community Outreach or Bookmobile service: *

Your Name: *

Your Email: *

Updated May 01, 2012

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Monroe County Public Library | 303 E. Kirkwood Ave., Bloomington, IN 47408 | (812) 349-3050