Homeschool Request Form
Use this form to request items to aid and enhance your lessons.

If you have any questions, contact Amy vanGoethem, Student Services Coordinator
avangoethem@cooklib.org 847-362-2330 x1179
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Email *
Full Name *
Home/Mobile Phone
When would you like to pick up your materials? *
Please allow at least 7 business days
MM
/
DD
/
YYYY
How would you like to receive these materials? *
Delivery is available to the district offices of District 68, District 70, and District 73
Grade level and/or age of students *
Number of students using the materials
Reading level of materials you are requesting *
Please check all that apply
Required
Types of materials needed *
Check all that apply
Required
Intended use of materials
For example, student reports, read-alouds, teacher background information.
Subjects needed
List of specific titles (if known)
May we substitute titles on the list above?
Clear selection
If we do not own a specific title you requested, would you like us to request it from another library? *
Please note: Due dates are usually established by the lending library.
Total number of each type of material needed
Would like a list of relevant databases?
Clear selection
Additional Comments
Submit
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