Resource Request Form
Contact Information
First Name
Last Name
Phone
Email
School Name
Resource Information
Resource Being Requested
Please select...
Distract-a-Match
Distracted Perfection
Drowsy Driving Goggles
Impaired Goggles
Marijuana Goggle Kit
Smash Match
Stop! Stack the Blocks
Tablets
Vape Escape
VR Goggles
You can only borrow up to 3 resources at one time.
Date Resource(s) Needed
Please select dates at least 2 weeks in advance.
Estimated Return Date
Items can only be held for a maximum of 2 weeks
Read and review our
loaned resources agreement
and then check the box below.
I have read and reviewed the loaned resources agreement
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Contact Information