Deaf-Blind Lending Library Request Form

Indicate your role*

Select or enter value

First Name*

Last Name*

Materials Borrowed Serial Numbers*

Please list the Code(s)/Title(s) requested to borrow.

Limit of 3 items.

Title of Book/Item*

Phone number*

Email*

Address*

Where should we mail the item(s) to?

Assurances*

I understand it is my responsibility to return these items in good condition within one month of receipt.

If books are not returned in good condition or returned then I assume the responsibility of payment, in full, to replace the materials borrowed.

Notes

Please return materials to:

Colorado Department of Education

Colorado Services to Children with Deaf-Blindness/ESSU

201 Colfax Avenue, Room 409

Denver, CO 80203

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