Welcome to Cleveland County, NC

Application for Outreach Services

First Name*

Middle Name

Last Name*

Date of Birth*

Driver License / Identification Card Number (Does not have to be NC! Does have to be current.)*

Email Address*

Phone Number*

Alternate Phone Number

Street Address (1)*

Street Address (2)

City*

Zip Code*

Complete mailing address (if different from above.)

Does your center want story time service and/or material delivery service?*

Yes, we would like story time service

Yes, we would like material delivery service

Yes, we would like both story time and material delivery service

No, we do not want story time or material delivery service

How many children does your center or school currently serve?*

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