Dear Educator:

Your Midlothian Public Library is here to help your students excel. In order to serve you better, please fill out this form at least once a week prior to the time an assignment is given. If duplicate copies of the assignment, supplemental reading lists, or other handouts are to be distributed to the students, we would love to have those too.

Today's Date:

The following assignment involving the use of library materials has been given in my class:

Length of Assignment - Dates

From To

Materials Which May Be Used In The Assignment Are:

Books Magazines Journals Encyclopedia Newspapers Online Reference Sources (World Book, Lands and People, Gale, Biography Resource...) Internet AV (DVD, CD, Etc.)

Other (Please Specify)

Special Instructions or Additional Comments: