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Teacher Information:
Teacher's Name:  
School Name:  
Teacher's E-Mail Address:  
Telephone Number:  
Preferred Method of Contact:    E-Mail   Phone

Assignment Information
Grade Level:  
Date assignment given:  
Date assignment due:  
Approximately how many students
are receiving this assignment?:  
Description of the assignment :  
Number of sources required:  
Acceptable Sources:    Books   Encyclopedias   Magazines Newspapers   Web Sites   Online Databases
Please describe any other specific requirements about sources. [example- students must have 3 book sources and 1 internet source] :  
Other Information :