Emma S. Clark Memorial Library
Assignment Alert Request Form
For Grades K through 6
For Teachers' Use Only

Advance notice about the assignment will assist the Emma S. Clark Library in providing your students with as many library resources as possible, based upon the details you supply on this form. We will do our best to accommodate your students.

Today's Date:
11/20/08 (One week's notice please.)

Teacher Name:

Phone:

School:

Grade:

# of Students:

Date Assignment Begins:

Date Assignment Ends:

Your E-mail Address:

Description of Assignment: Please identify the specifics of the assignment.

( You may also want to mail, fax or e-mail us a copy of the assignment. See contact information below.)

Indicate each type of source required for completion of the assignment.

Any Source May Be Used   No   Yes Books   No    Yes

Reference Materials   No   Yes Magazines   No   Yes

Newspapers   No   Yes Internet   No   Yes

Library Databases   No    Yes

Click the SUBMIT button ONCE when you are done.

Return to Kids' Page

Children's Services
Emma S. Clark Memorial Library
120 Main Street
Setauket, NY 11733
phone 941-4080
fax 941-4541
treehouse@emmaclark.org

Today's Date:	11/20/08 (One week's notice please.)
Teacher Name:
Phone:
School:
Grade:
# of Students:
Date Assignment Begins:
Date Assignment Ends:
Your E-mail Address:

Any Source May Be Used No Yes	Books No Yes
Reference Materials No Yes	Magazines No Yes
Newspapers No Yes	Internet No Yes
Library Databases No Yes

Emma S. Clark Memorial Library Assignment Alert Request Form For Grades K through 6 *For Teachers' Use Only*

Emma S. Clark Memorial Library
Assignment Alert Request Form
For Grades K through 6
For Teachers' Use Only