First Name*

Last Name*

Email*

Phone Number

Example: 0xxxxxxxxx

Mobile*

Example: 04xxxxxxxx

Title*

eg. Principal, Teacher, Librarian

I am expressing interest on behalf of my*

School/Organisation Name*

Street*

Suburb*

State*

Post Code*

Country

Website*

How many students/children do you support?*

Please select the program you are most interested in

Please explain why your school/community centre requires support for new books*

Approximately how many books do you have in your library?*

Have you received any financial support for books in the past 12 months?*

e.g. grants or donations

What is your annual budget for new books? *

Do you have a library?*

Do you run any library programs? Please explain*

How many librarians/ teacher librarians does your school or community group have?*

How would you describe the average condition of your current books? *

How did you hear about Dymocks Children’s Charities?*

Additional Questions/Comments

* I have read and understood the Terms of Agreement.