Your Name            Home Phone Number

School Name            School Phone Number

E-mail              Fax number 

How do you prefer to be contacted?  Home phone    School Phone   E-mail

Your CLEVNET Library Card Number  

(we will need this number if you wish for any materials to be requested for you from other libraries
 - these are subject to regular loan policies)

___________________________________________________________________________

Level of Items Needed:

• choose as many as you need

• hold down the SHIFT key to group levels

• hold down the CTRL key to make multiple individual selections

Grade Level                                     Reading Level

  Toddler Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grades 5-6 Grades 7-8 Grades 9-12                                Toddler Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grades 5-6 Grades 7-8 Grades 9-12

Number of items needed 

Specific items needed  (Please give as much detail as possible about the topic or assignment)

Please include Non-Fiction      Fiction      Both

Requested date of pickup 

 (please allow at least 2-3 working days for your request to be filled)

 Thank You!