Individuals | 

Washington, DC 20542 (202) 707-5100 www.loc.gov/nls

Application for Free Library Service: Individuals

Please complete this application and send it to the library serving blind and 

physically disabled individuals in your state. To find your local cooperating library, 

go to www.loc.gov/nls/find.html or call 1-888-NLS-READ (1-888-657-7323).

Please print or type

Name (Last) (First) (Middle)

Street address

City County State ZIP

Telephone (Daytime)

Telephone (Evening)

Date of birth

Gender

E-mail address

Alternative contact if you cannot be reached for an extended period:

Name Telephone

Check here if you have been honorably discharged from the United States military.

Indicate the primary disability preventing you from reading regular printed material. 

Check only one box. Eligibility must be substantiated. See eligibility criteria definitions. 

Blindness Physical disability Deaf-blindness

Visual impairment Reading disability

If you also have a hearing impairment please indicate the degree of hearing loss. 

Moderate—some difficulty hearing and understanding speech.

Profound—cannot hear or understand speech.

Notice: Records relating to recipients of Library of Congress reading materials are 

confidential except for those portions defined by local law as public information. 

To find out the extent to which the information provided on this application form 

may be released to other individuals, institutions, or agencies, consult the agency 

to which you are submitting this application.

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Individuals | 

Eligibility of blind and other disabled persons for loan of library materials

The following people are eligible for service: residents of the United States, including 

territories, insular possessions, the District of Columbia, and American citizens living abroad.

1. Those people whose visual acuity, as determined by competent authority, is 20/200 or

less in the better eye with correcting lenses, or whose widest diameter of visual field 

subtends an angular distance no greater than 20 degrees.

2. Those with physical disabilities are eligible as follows:

(a) Persons whose visual impairment, with correction and regardless of optical

measurement, is certified by competent authority as preventing the 

reading of regular printed material.

(b) Persons certified by competent authority as unable to read or unable to use regular 

printed material because of physical limitations.

(c) Persons certified by competent authority as having a reading disability resulting

from organic dysfunction and of sufficient severity to prevent reading regular printed 

material in a conventional manner. 

Certifying authority:

• In cases of blindness, visual impairment, or physical limitations, “competent authority” 

includes doctors of medicine; doctors of osteopathy; ophthalmologists; optometrists; 

registered nurses; therapists; and professional staff of hospitals, institutions, and public 

or private welfare agencies (e.g., social workers, case workers, counselors, rehabilitation 

teachers, and superintendents). In the absence of any of these, certification may be made 

by professional librarians or by any person whose competence under specific 

circumstances is acceptable to the Library of Congress.

• In the case of a reading disability from organic dysfunction, competent authority is 

defined as doctors of medicine and doctors of osteopathy who may consult with 

colleagues in associated disciplines.

To Be Completed by Certifying Authority (as defined above)

I certify that the named applicant requesting library service is unable to read or use regular 

printed material for the reason indicated on this form.

Signature ____________________________________________________________ Date _________________________

Please print or type:

Name Title

Organization E-mail

Address Telephone

City State ZIP

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Individuals | 

Veterans. According to Public Law 89-522, persons who are blind or have a physical 

disability who have been honorably discharged from the armed forces of the United States 

must receive preference in the lending of books, recordings, playback equipment, musical 

scores and instructional texts, and other specialized materials. 

 

Institutions. Please fill out the Application for Free Library Service for Institutions. 

Lending of Materials and Classes of Borrowers

Reading Preferences: Check A or B

Talking books and/or magazines Braille books and/or magazines

Materials: Please select the format of your reading materials. One or both are available. 

A. Do not select books for me. Send only the specific titles that I request.

B. I wish to have books selected for me.

Note: If you wish to have books selected for you, the library needs information about your 

reading interests. Please check the types of books or subjects you prefer. Check all that apply.

Age range: Adult titles Young Adult titles Children's titles Grade: 

Subject category:

Adventure Bestsellers Biographies

Business and Economics Career and Job Training Classics

Cooking Drama and Theater Fantasy

Gardening Gothics Government and Law

History (U.S.) History (World) Historical Fiction

Hobbies and Crafts Home Management Humor

Literature Medicine and Health Mystery and Detective

Nature / Environment Occult and Horror Philosophy

Poetry Psychology and Self-Help Religious Themes

Religion Romance Science and Technology

Science Fiction Spanish Language Spies and Espionage

Sports and Recreation Stage and Screen Suspense

Travel War / War Stories Westerns

Other preferences:

I do not wish to receive books that contain (check all that apply):

Strong language Violence Explicit descriptions of sex

I wish to receive books in the following languages (write in below): 

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Individuals | 

Books, magazines, materials, and equipment accessories 

Please check the box provided for any of the following items and/or services that you wish 

to receive.

Books and magazines recorded on 

digital cartridge with the digital 

talking-book player

Braille books and magazines

Braille and Audio Reading Download 

(BARD) service for personal computers 

and mobile devices (users supply 

equipment; requires a separate 

registration) 

Accessories for digital talking-book player

USB flash drive adapter (lets you use a 

personal flash drive with the player)

High volume player and headphones 

(issued solely for use by readers with 

profound hearing loss; ask for a 

separate application)

Digital talking-book (DTB) cartridge 

cable (used to connect a DTB 

cartridge to a USB port on a 

computer 

Headphones

Pillow speaker (issued only to readers 

confined to bed)

Music materials

Music instruction on digital cartridge

Music magazines in braille

Music scores in braille

Music scores in large print

Music appreciation materials on 

digital cartridge

Music appreciation materials in braille

(Note: Recorded music for recreational 

listening is not available through this 

program.)

Return of Equipment

Playback equipment and accessories are supplied to eligible persons on extended loan. 

If this equipment is not being used for reading recorded material provided by the 

Library of Congress and its cooperating libraries, please return it to the issuing agency.

Where to Send

Mail this application to your local cooperating library found at www.loc.gov/nls/find.html

or call 1-888-NLS-READ (1-888-657-7323).

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