Book Intake Form

Book Intake Form

In The Human Library - Durham, "books" are volunteers who agree to to have 25 minute 1-on-1 conversations with "readers" about being exposed to stereotypes, stigma, or discrimination. Please fill in this intake form to the best of your ability. Once processed you will be contacted by the local Human Library organizer. Thank you for your time and interest in working with the Human Library - Durham.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Preferred Phone Number

Area CodePhone Number
Who referred you?
(if applicable)
Why would you like to become a human book for us?
Please provide us with examples of prejudices and stereotypes you have faced or experienced in your life?
What would you like to share with your readers?
What title would you select for yourself?
Titles should be BRIEF (ie. Deaf Woman, First Generation Pakistani-American) and reflect an area where you have experienced stereotype or prejudice.
Where did you hear about The Human Library - Durham?
Have you ever participated in a Human Library event before?

YesNo

When would be the best general time(s) for a brief phone or in-person chat with you to describe the event in more detail and answer any questions you may have?

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning (9:00 AM - 12:00 noon)
Afternoon (12:00 noon - 5:00 PM)
Evening (5:00 PM - 8:00 PM)

Please tell us what languages you speak
We welcome multi-lingual volunteers to also serve as translators!
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