Teacher's/Homeschooler's Loan Request Form Name Today's Date * Date of Pickup * **Please allow at least 7 days Name * School's name or homeschool * School Phone Number * Include extenstion Email * Home or Cell Number Library Card Number * Prefered Method of Contact * School Phone Home or Cell Phone Email Age/Grade Level(s) of Students * Number of Students * Special Needs, if any, of the Students * Reading Level of Students * Below Reading Level At Reading Level Above Reading Level Select all that apply Subject(s) Needed/Intended for Use * Include if this is for teacher use or research, student use or research, read alouds, etc. Approximate Number of Materials * Kinds of Formats and Materials Needed * Fiction Nonfiction Picture Books Videos (DVDs, Blurays, etc.) CDs Other (Specify below) Titles of Specific Materials If applicable
