Please fill in this form completely.

* Date of Request:
* Teachers Name:
* School:
* Phone (Home):
* Phone (Work):

* Date of Expected Pickup:
Requests should be made at least one week
advance of the pickup date that you select:

* Subject Area (Please be as specific as possible):

* Grade or Age Level:

* Formats (Check the boxes to all those that apply to what is needed):
Fiction Non-Fiction Magazine Articles
Videos Websites Other

* Number of Items Needed (Limit 20):

Any additional Comments (optional):

Pick up items at the Children's Question Desk on the lower level of the library.
No Holiday books please.

All items will be returned to the shelves on the day after the requested date of pickup unless we are notified.