Lending Library Material and Professional Book Request Form

Families, teachers, and others for children who are visually impaired/blind or deafblind may borrow products from the Lending Library for up to 3 months. Outreach also offers to Missouri educators professional materials, class textbooks and other textbooks on topics related to the development and education of students with visual impairments.

These resources are provided so that one can trial products or determine whether the product may be helpful to purchase.

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* 1. NAME OF THE PRODUCT(s) or BOOK(s) YOU ARE REQUESTING

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* 2. ADDRESS AND CONTACT INFO TO SEND YOUR REQUEST

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 3. NAME OF YOUR SCHOOL AND COUNTY

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* 4. Who are you?

I am blind/visually impaired/have low vision

I am a parent

I am an educator of a student

Other (please specify)

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* 5. Is the student/child registered with the APH Federal Quota?

Yes

I do not know