Common Contracts

Borrower Policy & Agreement Form

May 11th, 2022

• Filed
  May 11th, 2022

Household Size (Number of persons in family) Check one box □ 1 person □ 6 persons□ 2 persons □ 7 persons□ 3 persons □ 8 persons□ 4 persons □ Over 9 persons□ 5 persons Household/Family Income Summary Check one box □ $39,150 or below family income□ $65,250 or below family income□ $104,400 or below family income□ $137,850 or above family income Hispanic: Yes / No□ White□ Black/African American□ Asian□ American Indian/Alaskan Native□ Native Hawaiian/Pacific Islander Ethnicity Check one box □ American Indian/White□ Asian/White□ Black/White□ American Indian/Black□ Other/Multi-Racial I acknowledge that the Tech Lending Library Services are intended for library patrons who do not otherwise haveaccess to the equipment or services sufficient to meet the patron’s educational needs. To the best of my knowledge, the information above is correct and I fully understand that the information provided will be shared with the Library Services special grant reporting purposes, where names and ident