Form: Teacher Collection Request

Enter Your Full Name (Required):

Enter Your Telephone Number (Required): Example: 859-555-9999 or 555-9999

Enter Your Email Address:

Where do you teach?

School's Telephone Number: Example: 859-555-9999 or 555-9999

What subjects would you like? (Required)

(Note: Seasonal topics available in limited amounts)

Types of books to include:

• Fiction
• Non-Fiction

Other media to include:

• DVDs
• Music
• Books on Tape
• Videos

Grade level of materials to pull? (Required)

How many titles would you like? (Required)

Date Needed: (Allow 2 weeks) Required format: MM/DD/YYYY

Choose a pick-up location. Main Library Children's Center Scheben Children's Center Scheben Circulation Desk Regularly Scheduled CCoW Visit Florence Branch Lents Branch Walton Branch

(Please use the space below to provide any additional information.)