Welcome to Cleveland County, NC

Application for Homebound Services

First Name*

Middle Name

Last Name*

Date of Birth*

Under 16?*

Yes

If under 16: Name of parent or legal guardian

Driver License / Identification Card Number (Does not have to be NC! Does have to be current. If applicant is under 16, use parent or legal guardian's.)*

Email Address*

Phone Number*

Alternate Phone Number

Street Address (1)*

Street Address (2)

City*

Zip Code*

Complete mailing address (if different from above.)

What days and times (between Monday - Thursday, 9:00 AM to 4:00 PM) would you prefer service?*

I verify that the address listed above is my current mailing address.*

I Agree

I Disagree

I verify the information provided above is correct to the best of my knowledge. I understand that I will not be issued a new library card if I have an existing account, or an expired account with a balance. (Library staff will contact you if this is the case.)*

I Agree

I Disagree