Teacher Request Form
Use this form to request items for your classroom 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 *
School Phone
Home/Mobile Phone
School *
If you selected other above, with what school are you affiliated?
When would you like to pick up your materials? *
Please allow at least 7 business days
How would you like to receive these materials? *
Delivery is available to the district offices of District 68, District 70, and District 73
Types of materials needed *
Please check all that apply.
Grade level of students *
Please select all that apply.
Age of students
Reading level of materials you are requesting
Please check all that apply
Intended use of materials
For example, student reports, read-alouds, teacher back ground 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.
Number of students using the materials *
Additional Comments
Clear form
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