Please fill out this form completely. We would appreciate at least one week's notice. We also invite you to come into the library to see our available resources before you make assignments or you may call in and we will check for you.

Today's Date ___________   Teacher's Name_____________________________

Teacher's Email __________________________________   School ____________________

School's Phone _______________   Grade ______   Subject ______________

Date of Assignment: From ___________ To ____________   Num. of Students _____

Description of Assignment (please attach a copy if possible): ________________________________________________________________________ ________________________________________________________________________
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Length of Assignment _____________   Number of Sources Needed _______

Choose any of the following acceptable sources:

___Any source        ___Newspapers         ___Magazines          ___Fiction

___Non-Fiction       ___Internet                ___AV                     ___Other ________________

List any books, periodicals, internet sites, or reference materials you recommend for this assignment or you would like us to purchase. We will consider this request, but cannot guarantee the materials will be purchased in time for this assignment.
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Assignment Restrictions (ex. no general encyclopedias) __________________________
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Is this an annual assignment? ______

How can we contact you if we have questions? ___Phone ___Email ___Fax: ________________

Please mail or fax this to the public library that is closest to your school:

Thank you for taking the time to help us help the students of Gloucester County.