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State of Iowa

info@iowa.gov

200 E Grand, Des Moines , IA, 50309, US

Application for Free Library Service for Institutions

Iowa Library for the Blind and Print Disabled

Application for Free Library Service: Institutions Institutions—such as assisted living communities, hospitals, public libraries, schools for students who are blind or have a visual impairment, public and private schools, and college or university disability centers—may borrow equipment and reading materials for use by eligible readers to use individually or in a group setting. The institution is responsible for keeping a record of the serial numbers of all machines assigned to the institution. If residents or students choose to apply using the Individual Application, they are responsible for the equipment they borrow, not the institution.

Full Address

Number of persons unable to read or use standard printed materials who will be served (Note: a patron can be both talking-book reader and a Braille reader):

Type of Institution:

Demonstration Account:

Eligibility of blind and other print-disabled persons for loan of library materials

The following people are eligible for service: residents of the United States, including territories, insular possessions, and the District of Columbia, and American citizens living abroad, provided they meet one of the following criteria:

1. An individual who is blind or has a visual impairment that makes  them unable to comfortably read print books.

2. An individual who has a perceptual or reading disability.

3. An individual who has a physical disability that makes it hard to hold or manipulate a book or to focus or move the eyes as needed to read a print book. Please see www.loc.gov/nls/eligibility for the full eligibility terminology.

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

Certifying Authority Information

Facility

Facility Address

Staff member who will be responsible for this service (person to be contacted by the library):

Books and Materials

Please check the box provided for any of the following items and/or services that you wish to receive:

Items/Services

How did you learn about the NLS free library service (check up to 3 that apply?)