Teacher's Name:  

School Name

Grade Level Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12  School Phone:

Please tell us your subject:

Home phone:

What's your E-mail address?

Describe the Assignment:


Date assigned: Date assignment due:

What materials may be used in the assignment?

Books Magazines Videos

Library Databases Internet Encyclopedias

Pamphlets Recordings

Other Materials Needed (Please specify)


Would you like a reserve shelf for this assignment? Yes No
If yes... In-library use only Three day loan period

Main Library Bellville Branch Butler Branch

Crestview Branch Lexington Branch Lucas Branch

Madison Branch Ontario Branch Plymouth Branch

Thank you for your cooperation.