Instructional Materials Request Form
Please complete one form per textbook or workbook.
Fill out as much information as possible provided with quote (if applicable), online source, or information gathered from the physical copy you are requesting. The UPC code on a physical textbook contains 2 sets of numbers. The 13-digit number is same as the ISBN needed for ordering. If there is only a 10-digit number, please include that instead.
After submitting online form, please send a quote (if applicable) via pony or email to Lori Garcia.
If you have any questions or need help filling out this form, please contact Lori at extension 5954 or
By selecting YES as a response, you are confirming you have discussed the request with your Academic Dean.
YES - I have discussed this with the Academic Dean
NO - I have not yet discussed this with the Academic Dean
Name of person placing order:
(Who to deliver to:)
Please list each course name & number (be specific, IV AP, AP, PAP, etc.)
Languages Other Than English
AH High School
AH Junior School
Howard Early Childhood Center
Grade (Select all that apply)
Please include FULL TITLE and EDITION if applicable
ISBN: 13 digits (typically same as barcode) or 10-digit if 13-digit is unavailable
For non-textbook materials, please include item number. If unknown, type unknown.
Houghton Mifflin Harcourt
Bedford Freeman & Worth
Other (Please List in next entry)
Other Publisher Entry
Select Language of Materials
Student or Teacher Edition?
Does Not Apply
What percentage of TEKS does this material cover?
Publisher should be able to provide this info with quote. If under adoption, info is listed on Proclamation document. If you are unsure, type "Unknown"
HARD COPIES Requesting
Enter the number of books you are requesting. If you need books for the entire enrollment within a grade level or course, please write the word ENROLLMENT.
Type of Online Version Requesting
YES - Digital via CD ROM or Software
YES - Online License
YES - Individual Book Codes
How many DIGITAL VERSIONS / LICENSES are you requesting?
NOTE: If based on enrollment projections, type ENROLLMENT. This can be a different number than Hard Copies when purchasing class sets.
If this is a package deal or has ancillary materials, please describe here.
How many teacher editions do you need to accompany this title?
Include sales rep name, phone number and website here (if available or applicable).
If unknown, leave blank.
Budget Code to use ONLY if different from IMA (textbook) funds
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of Alamo Heights ISD.