Antwerp Local School District Instructional Resource Request Form
This form should be completed by the teacher prior to completing a requisition. Once submitted the requisition will go to your Building Principal for approval or discussion.
Teacher(s) making request:
Your answer
Date Requested:
MM
/
DD
/
YYYY
Building:
Type of Resource:
Required
Resource description: Please describe what you are asking the district to purchase (vendor, licenses/copies needed, support needed, etc.)
Your answer
Estimated cost:
Your answer
Funding source, if known.
Your answer
Provide a summary of why the resource is being requested, including how it will support or extend instruction within the context of your content standards and how it will impact student achievement.
Your answer
How did you determine that this resource will meet your needs?
Your answer
How will you evaluate the impact on student achievement?
Your answer
Please explain how current resources do not meet your instructional needs.
Your answer
Indicate the estimated percentage of time this resource will be used.
Your answer
Is this a resource that can be shared with other classrooms?
Submit
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