Request Form for Textbooks, Standardized Tests, and Individual Instructional Materials
The School Year Ending June 2020

The State of Minnesota has authorize local public school districts to loan textbooks, standardized tests, and individualized instructional materials to pupils attending a nonpublic school, (includes home schools), established and operating within the same school district boundaries. These materials must be secular in nature, designed primarily for individual use by the pupil in a particular class or program in the school the pupil regularly attends, and must be requested by, or on behalf of, the pupil no later than September 15, 2019.

*Please check "YES". This allows us to accept government textbook allocation for our school.

Student's First Name *
Your answer
Student's Last Name *
Your answer
Grade Level *
Name of School *
Request textbooks, standardized tests, and individual instructional materials *
Verification of Use: I hereby verify that the textbooks and individual instructional material requested are to be used by the pupil above in a course of instruction in that pupil's elementary or secondary school. *
Parent Signature
I have agreed to submit this form by electronic means. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. * By typing my name below, I am electronically signing my form.
Your answer
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