Program Application for Books

Program Application for Books
Please request books at least one month in advance of date needed.

Read to Grow provides free books to Connecticut families and programs that serve children. Unfortunately we cannot provide books to those outside of the state at this time.

Tell us about yourself: (* denotes required fields)
Date
Official School / Organization Name		Your Title *
Your First Name *		Your Last Name *
School/Organization Address		City
State       Zip		Program Phone *
County * Fairfield Hartford New Haven New London Middlesex Litchfield Tolland Windham		Program Email *
Are you a state agency? Yes No		Are you a municipal agency? Yes No
Type of Program? *: DCF/DSS Health care facility in-home child care child care center Head start program book bank home visiting program community organization Other If other please specify *:
Are you a Title I program? Yes No
Please describe your program: How many books are you requesting (please be specific)? Number of children to be served? Special requests (board books, picture books, chapter books, non-fiction, series): If non-fiction, specify subject(s): How will the books be used? * Lending Library Take Home Curriculum Support Special Event Other If other please specify *: If request is for a special event, by when are the books needed?   Age(s) of book recipients: Reading level (if applicable): How did you hear about Read to Grow? *: TV/newspaper Teacher/Childcare Provider Home Visitor Internet Library Friend/Family Member In Hospital When My Baby Was Born Other Hospital Name: If other please specify: Enter the code shown above More Info Why Do I Need to Enter This Code? By entering the code you see in the box, you help us prevent automated registrations. This reduces system loads and ensures better performance of our services. If no image appears, please make sure your browser is set to display images and try again. If you are not sure what the code is, make your best guess. If you guess incorrectly, you will have an opportunity to enter a different code on the next screen. Visually impaired or blind users: please contact us for assistance.  Top      Printer Friendly