Textbook Checkout Form

Student Name: _________________________________
Grade in School:
Name of Course:

10th

11th

12th

Algebra 2 Block: _____________

Textbook Checkout Form
Student Name: _________________________________
Grade in School:
Name of Course:

10th

11th

12th

Algebra 2 Block: _____________

Textbook Number: ______________________________
PLEASE WRITE YOUR NAME NEATLY IN YOUR
TEXTBOOK IN PEN!

Textbook Number: ______________________________
PLEASE WRITE YOUR NAME NEATLY IN YOUR
TEXTBOOK IN PEN!

Rate your Textbook Condition (circle one):

Rate your Textbook Condition (circle one):





New
Great
Good
Fair
Poor

How many students have
previously used this textbook?
_________________





New
Great
Good
Fair
Poor

How many students have
previously used this textbook?
_________________

Additional comments (stains, binding, tears, etc):
______________________________________________

Additional comments (stains, binding, tears, etc):
______________________________________________

_______________________________________________________

_______________________________________________________

______________________________________________

______________________________________________

TO BE COMPLETED BY MRS.HEDGE:

TO BE COMPLETED BY MRS.HEDGE:

Textbook was returned on: _______________________

Textbook was returned on: _______________________

Textbook Checkout Form

Textbook Checkout Form

Student Name: _________________________________
Grade in School:
Name of Course:

10th

11th

12th

Algebra 2 Block: _____________

Student Name: _________________________________
Grade in School:
Name of Course:

10th

11th

12th

Algebra 2 Block: _____________

Textbook Number: ______________________________
PLEASE WRITE YOUR NAME NEATLY IN YOUR
TEXTBOOK IN PEN!

Textbook Number: ______________________________
PLEASE WRITE YOUR NAME NEATLY IN YOUR
TEXTBOOK IN PEN!

Rate your Textbook Condition (circle one):

Rate your Textbook Condition (circle one):





New
Great
Good
Fair
Poor

How many students have
previously used this textbook?
_________________





New
Great
Good
Fair
Poor

How many students have
previously used this textbook?
_________________

Additional comments (stains, binding, tears, etc):
______________________________________________

Additional comments (stains, binding, tears, etc):
______________________________________________

_______________________________________________________

_______________________________________________________

______________________________________________

______________________________________________

TO BE COMPLETED BY MRS.HEDGE:

TO BE COMPLETED BY MRS.HEDGE:

Textbook was returned on: _______________________

Textbook was returned on: _______________________

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