NYS Textbook Loan Request for Non-Public School Students
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Student Name
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First Name
Last Name
Student Birthdate
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Must contain a date in M/D/YYYY format
Student Grade Level
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K
1
2
3
4
5
6
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8
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10
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School Name
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Brunswick School
Hackley School
Regis High School
The Masters School
Trinity Pawling
Other (please specify below)
Please Specify Your School Name:
Is this your first time requesting text books from WPCSD?
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Home Address
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City
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State
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NY
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Zip
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Must contain only numbers
Parent/Guardian First Name and Last Name
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First Name
Last Name
Home or Cell Phone (include area code). No Spaces or dashes.
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Must contain only numbers
Email Address
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Book Order 1
Book 1 ISBN# (10 or 13 digits)
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Must contain only numbers
Book Title
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Edition
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Author
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Price
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Vendor
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Book Order 2
Book 2 ISBN# (10 or 13 digits)
Must contain only numbers
Book Title
Edition
Author
Price
Vendor
Book Order 3
Book 3 ISBN# (10 or 13 digits)
Must contain only numbers
Book Title
Edition
Author
Price
Vendor
Book Order 4
Book 4 ISBN# (10 or 13 digits)
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Book Title
Edition
Author
Price
Vendor
Book Order 5
Book 5 ISBN# (10 or 13 digits)
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Book Title
Edition
Author
Price
Vendor
Book Order 6
Book 6 ISBN# (10 or 13 digits)
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Book Title
Edition
Author
Price
Vendor
Book Order 7
Book 7 ISBN# (10 or 13 digits)
Must contain only numbers
Book Title
Edition
Author
Price
Vendor
If you have more than 7 books to request. Please complete an additional form.
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