Collection Request Form
Preschool - 6th Grade

Use this form to request that a collection of thematic materials be gathered for you to use in your home school curriculum. A valid Teacher Card is required to receive this service.

      Name:

      Phone Number:

      Email Address: (optional)

      Teacher Card Number:

      Grade or Age Level:

      Please describe the topic(s) you need:

      How many fiction books would you like?

      How many non-fiction books would you like?

      What other formats are you interested in using? (check all that apply)
      magazines
      cassettes
      book/cassette kits
      videos
      CDs
      other:

      Please indicate if there are any sources that you do
      NOT wish to use (e.g., encyclopedias, etc.):

      When would you like to pick up these materials?

      (Allow at least one week.)

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Children's Department Home Page
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Massillon Public Library - 208 Lincoln Way East * Massillon, Ohio 44646 * USA
childrens-department@usa.net - 330-832-5037