Sign Up Form for the Bridge Technology Services Assessment Toolkit

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* 1. Library System Information

Name of Your Public Library System:

Address:

City/Town:

Postal Code:

Website:

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* 2. Library Contact Information (Main Contact)

Full Name:

Position Title:

Telephone Number:

Email:

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* 3. Library Contact Information (Back Up Contact)

Full Name:

Position Title:

Telephone Number:

Email:

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* 4. Please describe the community that your library serves e.g. population size, demographics, technology skill level, interest, and need (250 words max).

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* 5. Please provide a summary of technology your library provides (250 words max).

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* 6. Please provide a summary of technology programs (e.g. user / digital literacy training) your library provides (250 words max).

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* 7. What are the anticipated benefits for using Bridge at your library and community? (250 words max).

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* 8. Is there anything else we should know about your library system?