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NYS Textbook Loan Form

Please complete the form below for each student. Required fields marked with an asterisk *

Student Name*

Answer Required

Student Address*

Answer Required

Name of Public School District residing in:*

Answer Required

I hereby request the Loan of Textbooks in the name of (student name):

Answer Required

By checking the box below, I agree to authorize St. Gregory the Great School to act on behalf of this student in identifying and ordering books loaned to the student identified above, and residing in the district above, must maintain in good condition each book received. If book is damaged or lost, that student will be responsible for replacing the book as new.*

Answer Required

I Agree

Parent or Guardian Name*

Answer Required

Today's Date*

Answer Required

This form is to be kept on file in the individual non-public school for the duration of enrollment.