Teacher's Name

School	Today's Date
Phone Number	Email

Grade/Age Level

Date Materials Needed

Date of pick-up

Description of Items needed (book, DVD, magazine, etc.)

Number of Items needed:

Subject or Titles needed:

Please allow up to 2 weeks for us to request and receive items from the other locations for you. Items received and ready for pickup will be held for 7 days, unless card-holder contacts our staff for pick-up extension.