LINCOLN PUBLIC SCHOOLS
2015-2016
Request for textbook LOANS
Student’s Name _______________________________________________________
(Last Name)
(First Name)
Street Address __________________________________________Zip___________
School Attending _________________________________________Grade _______
ENGLISH
Title of Book __________________________________Copyright ________
Author ____________________________Publisher____________________
* ISBN 10-13 digits __ __ __ __ __ __ __ __ __ __ __ __ __ (include hyphens)
Book received by:
Date:
MATH
Title of Book __________________________________Copyright ________
Author __________________________Publisher______________________
* ISBN 10-13 digits __ __ __ __ __ __ __ __ __ __ __ __ __ (include hyphens)
Book received by:
Date:
SCIENCE
Title of Book __________________________________Copyright ________
Author __________________________Publisher______________________
* ISBN 10-13 digits __ __ __ __ __ __ __ __ __ __ __ __ __ (include hyphens)
Book received by:
Date:
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LINCOLN PUBLIC SCHOOLS
2015-2016
Request for textbook LOANS
Student’s Name _______________________________________________________
(Last Name)
(First Name)
HISTORY/SOCIAL STUDIES
Title of Book _________________________________Copyright ________
Author __________________________Publisher_____________________
* ISBN 10-13 digits __ __ __ __ __ __ __ __ __ __ __ __ __ (include hyphens)
Book received by:
Date:
MODERN FOREIGN LANGUAGE
Title of Book ___________________________________Copyright ________
Author ___________________________Publisher______________________
* ISBN 10-13 digits
__ __ __ __ __ __ __ __ __ __ __ __ __ (include hyphens)
Book received by:
Date:
I hereby certify that I am a resident of the Town of Lincoln and I agree that the
textbooks named above will be returned to Lincoln Public Schools on the
designated date in good condition and, if lost or abused, I agree to pay for its
replacement, due consideration being given for normal wear and usage.
NOTE: If books are not returned or are damaged, you will be billed for
the replacement.
_______________________________
____________________________
Parent/Guardian Signature
Telephone Number (required)
____________________________
__________________________
Parent/Guardian Name (Print)
Email Address
______________________
Today’s Date
Books must be returned by: June 2016
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