Instructions for Completing the Annual Student Listing Form

Wolfner Library, a regional library of the National Library Service for the Blind and Physically Handicapped (NLS), must comply with the federal regulations governing NLS regional libraries. Every school year, each school using NLS equipment and books must submit the Annual Student Listing Form to Wolfner Library. This list must include the name, home address, and disability of each student who will be using Wolfner Library services. The Youth Services Librarian is required to check the names against the patron database. Each student must have an individual application on file with the library. You will be notified which students, if any, do not. We appreciate your cooperation in complying with these regulations. Please follow the instructions below to avoid delays in receiving library service this school year.

• Submit a separate form for each school in your district that needs library service this year.
• List a student’s legal first and last names. Do not use nicknames.
• You must provide the student’s current home address.
• Identify each student’s disability, using the following abbreviations as appropriate. We do not need or want further explanation.
  • B (blind)
  • VI (visually impaired)
  • P (physical disability)
  • RD (reading disability)
• Please note: Students with learning disabilities, attention deficit disorder, attention deficit-hyperactivity disorder, chronic-fatigue syndrome, autism, functional illiteracy, or developmental disabilities are not automatically eligible. They must have, in addition, a specific accompanying visual or physical disability that makes them eligible for this particular service.
• List only five students per page. Duplicate the form if necessary.
• A professional member of the school’s staff (principal, certified teacher, school librarian, counselor, registered nurse) must sign the student listing form in blue ink. Signatures of nonprofessional or paraprofessional support staff cannot be accepted.
• Students named on the annual student listing form must attend the school requesting service.
• Designate one contact person to receive all library materials for the school. Include that person’s name and email address on the form. All materials will be sent to the attention of the designated contact person.
• If you want the materials to be mailed to the designated person at a location other than the school (for example, the designated person’s office), include that address information on the back of the form.
• Equipment and books checked out to the school are the property of the federal or state government and are the responsibility of the school.
• Equipment is charged out to a specific school. Please do not move equipment to another school without notifying the library. If you need more equipment, call Wolfner Library
• Mail (do not fax) the completed student listing form to:
  

  Wolfner Library for the Blind and Physically Handicapped
  Attention: Youth Services Librarian
  PO Box 387
  Jefferson City, MO 65102-0387

 

Revised 06/2007