Book Box Form: 3-5

Contact Information

Full Name

Email

School Name

School Address (include street, town, state, and zip code)

Group Information

Grade Level(s) (of students utilizing books)
3rd Grade4th Grade5th GradeOther

If you selected Other, please indicate grade level.

Number of students served (approximate number of students that will be served in the current school year)

Note: You will be provided with one copy of each picture book requested and up to 40 books (one classroom set) for each novel requested. Refer back to this list for more details about each book.

Which book(s) are you requesting, please select all that apply.

Picture Books

As Good As Any­body: Mar­tin Luther King Jr. and Abra­ham Joshua Hes­chel’s Amaz­ing March Toward Freedom by Richard MichelsonRose Blanche by Roberto Innocenti

Novels

NOWHERE BOY by Katherine MarshNumber the Stars by Lois LowryOnce by Morris GleitzmanOut of Hid­ing: A Holo­caust Survivor’s Jour­ney to America by Ruth Gruen­erRefugee by Alan GratzThe Devil’s Arithmetic by Jane Yolen

For novels, please indicate how many copies you would like to receive. Please consider requesting additional copies for lost or damaged books. If you are only requesting picture books, enter 0 below.

Additional Information

How did you learn about OJMCHE's Book Box program?
OJMCHE NewsletterOJMCHE WebsiteColleagueOther OJMCHE Programming/OfferingOther

If you selected Other, please let us know how you found out about OJMCHE's curriculum.

Which of the following OJMCHE curriculum or programming have you used before?
Lesson PlanDigital Curriculum/ExperienceMuseum VisitClassroom VisitSpeakers' BureauMemorial TourProfessional DevelopmentI have not used these resources before.

Are you interested in returning your books after use?
YesNo

Additional comments/questions: