Student Textbook Checkout

NOTE: **Textbooks are mailed to the student’s attending High School. We ask that the assigned eSchool Facilitator check the textbooks out to the students, and have them sign this form. We ask that the facilitator collect the textbooks at the end of the course, and return the textbooks to the eSchool office. In the event that the student damages or loses a textbook we ask the facilitator to collect replacement cost through your student obligation procedures.

After the form is filled out please send a copy of this form to the Wichita eSchool office, 412 S. Main, Wichita, Ks. 67202, or e-mail a copy to cclasen@usd259.net and keep the original for your records.

Student Name:___________________________________________________________________

School Name:____________________________________________________________________

Facilitator Name:__________________________________________________________________

Textbook Name:________________________________________Replacement Cost:___________

Student Signature:______________________________________Date:______________________

Facilitator Signature:_____________________________________________________________