Maurer Library

*Name of Teacher:

*Name of School:

*Address of School:

*Telephone:

*Email:

*Type of school (Check one): Middle School   High School

*Number of Students:

*Dates the trunk will be needed:

Are the students reading on at grade level?  Yes   No
  If not, please explain:
 

How will this information be used?
 

Format types of material you are interested in. (Check all that apply)
  Books
  Cassettes
  CD-ROM
  DVD
  VHS
  Posters
  Photographs
  Brochures