AGENCY AND SCHOOL APPLICATION - Hooked on Books for Kids
Please read conditions and criteria carefully before filling out and submitting this form.
Email address *
Name of agency or school: *
Your answer
Address of agency or school (including street number, city, zip code): *
Your answer
Agency’s or school’s contact person: *
Your answer
Phone number (work): *
Your answer
Phone number (home):
Your answer
E-mail address: *
Your answer
Fax:
Your answer
1. Provide 501(c) 3 number or PA sales-tax exempt number: *
Your answer
2. How many children do you serve? *
Your answer
2A. What percentage of these children are economically disadvantaged? *
Your answer
2B. Explain how you determined this percentage (e.g. school lunch program, subsidized housing): *
Your answer
3. How many books are you requesting? (Limit is 400 for agencies; one per child for schools) *
Your answer
4. Explain how these books will be distributed to the children (Note: Books may not be used as prizes or incentives): *
Your answer
5. For schools only: Explain how these books will be used in a program to encourage parents to read to or with their children or as part of a home reading program:
Your answer
6. Please specify your needs as accurately as you can by stating the number of BOYS and the number of GIRLS for each of the following age ranges: *
Birth-3 years // 4-6 years // 7-8 years // 9-10 years // 11-13 years // 14-18 years
Your answer
7. Describe any special needs (e.g. easy reading, multi-cultural books, etc.)
Your answer
PLEASE NOTE:
Schools and classroom teachers must submit their requests and pick up their books between January 2 and September 30 of each calendar year.
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