Application for Free Library Service

Iowa Library for the Blind and Print Disabled

The Iowa Library for the Blind and Print Disabled provides services to individuals with:

Blindness
A visual disability that prevents the reading of standard printed material.
A physical disability, such as multiple sclerosis, paraplegia, or paper allergies, that interferes with the ability to hold a book and turn pages.
A reading disability resulting from organic dysfunction.

Hospitals, nursing or convalescent homes, schools or other institutions serving visually or physically disabled persons may also register with the library.

Certification

Applications for LBPD service must be certified by a competent authority.

In the case of visual or physical disability, a competent authority is defined to include:

physician
osteopath
ophthalmologist
optometrist
registered nurse
therapist
professional staff of hospitals, institutions, and public or welfare agencies (e.g., social worker, case worker, counselor, rehabilitation teacher, or superintendent).
professional librarian

More information about the certification for individuals with reading disabilities may be found in Talking Books and Reading Disabilities, a factsheet produced by the National Library Service for the Blind and Print Disabled.

County

Phone Number

Gender

Male

Female

Additional Information

By law preference in lending of books and equipment is given to veterans. Please check here if you have been honorably discharged from the armed forces of the United States.

Email me a username/password for the online catalog

By checking this box you are indicating that you would like us to send you occasional emails notifying you of special events and other opportunities. We honor your privacy and will never share your information with outside groups.

Contact Person: Person to contact if you can’t be reached or can assist with your account:

Contact Person Name

First

Last

Contact Person Information

Contact Phone

Contact Email

Relationship to Contact Person

Eligibility Requirements

Blindness: Visual acuity of 20/200 or less in the better eye with correcting lenses or the widest diameter of visual field is no greater than 20 degrees

Visual Impairment: Inability to read standard print materials with correction and regardless of optical measurements

Physical Disability: Inability to read or use standard printed materials as a result of physical limitations

Deaf Blind

Reading Disability: Inability to read or use standard print materials as a result of a perceptual or reading disability.

Certifying Authority Information

In the case of visual or physical disability, Please list below a competent authority is defined to include:

physician
osteopath
ophthalmologist
optometrist
registered nurse
therapist
professional staff of hospitals, institutions, and public or welfare agencies (e.g., social worker, case worker, counselor, rehabilitation teacher, or superintendent).
professional librarian
Can even be a close friend or neighbor

THE CERTIFYING AUTHORITY CANNOT BE THE APPLICANT OR A FAMILY MEMBER.

Certifying Authority Information

Name *

Title/Occupation *

Certifying Authority Email

Facility

Facility Name *

Facility Phone Number *

If you are a PreK-12th Grade Student fill out the following.

If this section doesn't apply to you click next to continue.

Student Current Grade

School Name

Teacher/TVI Information

TVI Name

TVI Phone Number

TVI Email

Library for the Blind and Print Disabled

Application for Free Library Service

Iowa Library for the Blind and Print Disabled

Library Services

Select the topics you would like to receive

If you are a PreK-12th Grade Student fill out the following.