STEM Materials Checkout Form
Sign in to Google to save your progress. Learn more
Use this Form to Checkout Material 
Last Name
 *
First Name
 *
Email Address
 *
School Phone Number
 *
Cell Phone Number
 *
School
 *
District
 *
Option Grade Teaching
 *
Required
Are you a Pre-service, In-service or non-formal educator?
 *
Materials(s) being requested 
1
2
3
4
5
6
7
8
9
10
11 to 15
16 to 20
21 to 25
26 to 30
more then 30
Books
Play doh
Hashtag blocks
Markers
Picasso toys
Pool noodles
Large rubber bands
Fins
Duck tape
Cut into 4 Legos
Keva planks
Brain flakes
Painters tape
Kinetic sand
Magna tiles
Marble runs
Craft sticks
String
Good kid scissors
Tape (all kinds)
Hot glue sticks
Pipe cleaners
Marbles
Rubber bands
Zip ties
Batteries
"PLUS PLUS" Blocks
Microscope
Magnifying glass
Circuit boards
Robotics kits
3D printer
Building blocks
Renewable energy kits
Magnetic tiles
Coding cards
Science experiment kits
Math manipulatives
Geometric shapes set
Measurement tools
Engineering design kits
Virtual reality headsets
Microcontrollers (e.g., Arduino)
Data collection sensors
Raspberry Pi kits
Science lab equipment
Ice cream sticks
Straws
Rubber bands
Paper clips
String or yarn
Balloons
Craft sticks
Pipe cleaners
Plastic bottles
Magnets
Playdough
Modeling clay
Paper
cardboard
Toothpicks
Marbles
Foam sheets
Rubber balls
Springs
Popsicle sticks
Elastic bands
others
Materials requested (list all and include quantity of each)
For materials other then list optional*
 *
Lesson Being Taught with Materials
 *
Number of students impacted
 *
Date Materials Needed
 *
MM
/
DD
/
YYYY
Anticipated Return Date
 *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.