Bookmobile Stop Application

Name:
Title:
Organization:
Street Address:
Town:
Zip Code:
Phone:
Email:
Location of Potential Bookstop: (Please be as specific as possible, e.g. east parking lot of ABC Apartments at 243 Your Street)
I have read the Indian Trails Public Library District Bookmobile Stop Criteria, and feel that this stop fits the criteria as a:	Community Stop Preschool Stop (Number of Students , serving ages ) School Stop (Number of Students , serving grades ) Senior Center/Assisted Living Center/Nursing Home Stop (Number of Residents )
Contact Person at proposed stop (if someone other than you):
Contact Person's Name:
Contact Person's Title:
Contact Person's Telephone Number:
Contact Person's E-mail:
Does the location have:	A parking space large enough for a 29 ft. long bookmobile? Parking for patrons? (Approximate number of parking spaces ) Restrooms that bookmobile staff might use?
Would your organization be able to help publicize this stop in the following ways?	Display a sign at your location? Publicize the stop regularly in your organization's newsletter? Distribute flyers supplied by the library?
Other reasons why you think this would make a good bookmobile stop: