Lane Public Library Classroom Collection Request Form

Pick-up Date (at least one week advanced notice needed): Today's Date:

For Bookmobile service drop off specify month:

Teacher Name: School:

Teacher's Email Address: Grade: Rm Number:

School Phone: Home Phone: Reading Levels:

# of items needed: May we make substitutions? Yes No

Teacher Barcode Number 21842:

Subjects:

Collection Should Include (Check all that apply. Please select at least one.): Fiction Nonfiction Poetry Videos DVDs

Music CD's Picture Books Easy Readers Book/Tape Kits Books on Tape Books on CD

Puppets (Animal/Person Preference) or Storytime Kits

CD ROM (Computer type)

Series or Type of Books for Class Personal Reading:

Please list specific titles you would like:

Please choose your pickup location:
Drop-off collections requests must be submitted to Bookmobile Services.

Would you like to pick up your items inside or at the drive thru (Hamilton & Fairfield only)