Bookmobile Request Form

(* denotes required fields)

Email:*

Organizer’s Full Name:*

Organizer’s Title/Role:*

Organizer’s Contact Email:*

Organizer’s Phone Number:*

Organization Name:*

Street address of site where Bookmobile would visit:*

City:*

ZIP Code:*

If other, please specify:*

Principal’s Email:*

Number of PRE-K classrooms visiting the Bookmobile:

Total number of PRE-K students visiting the Bookmobile:

Number of KINDERGARTEN classrooms visiting the Bookmobile:

Total number of KINDERGARTEN students visiting the Bookmobile:

Number of FIRST GRADE classrooms visiting the Bookmobile:

Total number of FIRST GRADE students visiting the Bookmobile:

Number of SECOND GRADE classrooms visiting the Bookmobile:

Total number of SECOND GRADE students visiting the Bookmobile:

Other grades, please contact [email protected]

Director’s Email:*

Number of INFANTS visiting the Bookmobile:

Number of TODDLERS visiting the Bookmobile:

Number of PRE-K visiting the Bookmobile:

If other, please specify:*

Event Date:*

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What is your role?

If other, please specify:*

Aside from English, are there any other languages spoken by the children who will be visiting the Bookmobile? While we cannot guarantee that we will be able to bring books in those languages, this helps us to serve our community better.

How did you learn about Read to Grow and/or the Bookmobile?*

Is there any other information you'd like us to have?

Thank you for taking the time to submit a request for the Bookmobile! We will do our best to accommodate your request but cannot guarantee that we will be able to meet every request. Please reach out with any questions to [email protected].