Teacher Checkout Form
| Date:
9/18/02 |
Name:
Mr. Pencil |
| School: Free
Store Academy
|
Principal: Katie Gold
|
| Grade Level:
Second
|
# of Children You Teach: 25 |
|
|
CLASSROOM
SUPPLIES
(Please print clearly)
|
ITEM/QUANTITY
|
ITEM/QUANTITY
|
|
1. Colored
Pencils/ 1 Box
|
14. Folders/
25
|
|
2. Pencils/
3 Bundles
|
15. Maps/
25
|
|
3. Highlighters/
2 Bundles
|
16. Paints/
2
|
|
4. Pens/
2 Bundles
|
17. Copy
Paper/ 2 Reams
|
|
5. Backpack/
1
|
18. Spiral
Notebooks/ 2
|
|
6. Paperclips/
2 Boxes
|
19. Loose
Leaf Paper/ 2
|
|
7. Carpet
Squares/ 25 Squares
|
20.
Gluesticks/ 2
|
|
8. Water
Bottle/ 1
|
21. Calculator/
1
|
|
9. Puzzle/
1
|
22. Rulers/ 4
|
|
10. 3
Ring Binders/ 30
|
23. Pencil
Box/ 1
|
|
11. Kids
Scissors/ 1
|
24. Ink
Jet Paper/ 2
|
|
12. Adult
Scissors/ 1
|
25. Blazer
Hat/ 1
|
|
13. Books/
7
|
|
These
products are for use in my classroom only.
Signature:
Mr.
Pencil
Remember to thank our generous donors!
