Impact Library Program Application
Applicant Contact Information
Please note the Impact Library Program is only open to applicants in the United States.
First Name
Last Name
Phone
Organization Name (if applicable)
Email
Address Line 1
Address Line 2
City
State/Province
Postal Code
Country
The Impact Fund is only available to applicants in the United States.
Is the Library's location the same as the applicant address above?
Yes
No
Library's Location
Address Line 1
Address Line 2
City
State
Postal Code
Country
The Impact Fund is only available to applicants in the United States.
Is the shipping address where the Library should be sent the same as the applicant address above?
Yes
No
Shipping Address
Address Line 1
The shipping address must be a U.S. address.
Address Line 2
City
State
Postal Code
Please describe the needs of your neighborhood or community, and share how a Little Free Library book-sharing box will address that need:
200 words maximum
I authorize Little Free Library to use the submitted story above at their discretion, in print and electronic materials. I understand that my contact information will never be shared with outside parties without my permission.
Yes
No
How did you find out about this opportunity?
I agree to the following obligations if I receive a Little Free Library:
I will install the Little Free Library at the location designated above.
I will maintain the Little Free Library for a minimum period of one year.
I will
add the Library's location and photo to the world map.
I will keep the Little Free Library stocked with books.
I will perform one or more Little Free Library neighborhood activities.
I will respond to media requests if contacted.
Yes, I agree to the above conditions.
Yes, I am 18 years or older
Do you wish to be considered for other free or reduced-cost Library opportunities?
Yes
No
Comments:
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