Polk County: Book Needs Survey

Please take a few moments to fill out this book needs assessment survey.

All information collected from this survey will give us an idea of how we should direct our resources to our community partners. Once you have completed this survey, someone will be in contact with you about your request to make arrangements for you to receive the requested books.

Thank You!
Michelle Bornfleth
503-623-9664
bornfleth.michelle@co.polk.or.us

Question Title

* Please provide your contact information:

Name: *

Organization/Program *

Address 1:

Address 2:

City/State

ZIP/Postal Code:

Website

Email Address: *

Phone Number:

Question Title

* If available, how many and what type of books would your organization/program like to request from Reading for All?

	0	1-50	51-100	101-150	151-250	250-400	401-550	550+
Toddler/Preschool books - English	Toddler/Preschool books - English 0	Toddler/Preschool books - English 1-50	Toddler/Preschool books - English 51-100	Toddler/Preschool books - English 101-150	Toddler/Preschool books - English 151-250	Toddler/Preschool books - English 250-400	Toddler/Preschool books - English 401-550	Toddler/Preschool books - English 550+
Toddler/Preschool books - Spanish	Toddler/Preschool books - Spanish 0	Toddler/Preschool books - Spanish 1-50	Toddler/Preschool books - Spanish 51-100	Toddler/Preschool books - Spanish 101-150	Toddler/Preschool books - Spanish 151-250	Toddler/Preschool books - Spanish 250-400	Toddler/Preschool books - Spanish 401-550	Toddler/Preschool books - Spanish 550+
Elementary age books - English	Elementary age books - English 0	Elementary age books - English 1-50	Elementary age books - English 51-100	Elementary age books - English 101-150	Elementary age books - English 151-250	Elementary age books - English 250-400	Elementary age books - English 401-550	Elementary age books - English 550+
Elementary age books - Spanish	Elementary age books - Spanish 0	Elementary age books - Spanish 1-50	Elementary age books - Spanish 51-100	Elementary age books - Spanish 101-150	Elementary age books - Spanish 151-250	Elementary age books - Spanish 250-400	Elementary age books - Spanish 401-550	Elementary age books - Spanish 550+
Middle & High school books - English	Middle & High school books - English 0	Middle & High school books - English 1-50	Middle & High school books - English 51-100	Middle & High school books - English 101-150	Middle & High school books - English 151-250	Middle & High school books - English 250-400	Middle & High school books - English 401-550	Middle & High school books - English 550+
Middle & High school books - Spanish	Middle & High school books - Spanish 0	Middle & High school books - Spanish 1-50	Middle & High school books - Spanish 51-100	Middle & High school books - Spanish 101-150	Middle & High school books - Spanish 151-250	Middle & High school books - Spanish 250-400	Middle & High school books - Spanish 401-550	Middle & High school books - Spanish 550+
Adult literature	Adult literature 0	Adult literature 1-50	Adult literature 51-100	Adult literature 101-150	Adult literature 151-250	Adult literature 250-400	Adult literature 401-550	Adult literature 550+
Bilingual (Spanish & English) books	Bilingual (Spanish & English) books 0	Bilingual (Spanish & English) books 1-50	Bilingual (Spanish & English) books 51-100	Bilingual (Spanish & English) books 101-150	Bilingual (Spanish & English) books 151-250	Bilingual (Spanish & English) books 250-400	Bilingual (Spanish & English) books 401-550	Bilingual (Spanish & English) books 550+

Other (if different amounts and/or types of books are required for your program, please describe the needs here)

Question Title

* What age range does your organization / program serve?

0-3 years old

4-6 years old

7-11 years old

12-18 years old

19+ years old

Question Title

* What community(ies) does your organization/program serve?

Dallas

Falls City

Grand Ronde/Willimina

Independence

Monmouth

Perrydale

West Salem

Question Title

* Who is the target audience of your organization/program?

Children

Special Needs Children

Adolescents

Parents

Grandparents

English Language Learners

Childcare Providers

Teen Parents

Other (please specify)

Question Title

* What other supports could Reading for All offer to your organization/program?

Classes

Literacy Trainings

Educational Resources and literature on reading

Volunteers

Bookmarks

Book Bags

Posters

Question Title

* Would your organization/program be interested in learning more about the Community Book Nook project?

Yes

Other (please specify)

Question Title

* Please provide your contact information:

Question Title

* If available, how many and what type of books would your organization/program like to request from Reading for All?

Question Title

* What age range does your organization / program serve?

Question Title

* What community(ies) does your organization/program serve?

Question Title

* Who is the target audience of your organization/program?

Question Title

* What other supports could Reading for All offer to your organization/program?

Question Title

* Would your organization/program be interested in learning more about the Community Book Nook project?

Question Title

* Is there anything else you would like Reading for All to know about your organization/program or its needs?