The Lane Libraries Classroom Collection Request Form
Teacher Cards Only
Teacher Name *
Your answer
School *
Your answer
Teacher's Email Address *
Your answer
Phone #
Your answer
Teacher Barcode Number *
All barcodes should begin: 21842
Your answer
Grade
Your answer
Room Number
Your answer
Pick Up Month *
or Drop-Off Month (for Bookmobile collections)
Pick Up Day *
At least two weeks advance notice is needed. If Bookmobile is dropping off your collection, choose BOOKMOBILE (bottom of list).
Please Choose Your Pick Up Location *
Subjects *
Please tell us what subject(s) you need and how you will use the materials (eg. silent reading, pair reading, reading aloud, independent reading, student research projects etc.); Include as many details as possible.
Your answer
Collection Should Include *
Check all that apply. Please select at least one.
Required
Specific Titles
Please list any specific titles you would like.
Your answer
Reading Levels *
Your answer
Number of Items Needed *
Your answer
Thank You!
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