Curriculum - New Material Request
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Name of Person Submitting the Request
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First Name
Last Name
Date of Application
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Must contain a date in M/D/YYYY format
Grade level requesting approval
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Title and Author:
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Publisher and Copyright Date
Type of Text
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Fiction
Non-Fiction
Curriculum Resource
Lexile/Reading Level:
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This Text is..
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Below Grade Level
At Grade Level
Above Grade Level
Literary awards/recognition/potential learning benefit from this text:
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Please provide a brief summary of the text:
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In what ways does this text support the following elements of quality learning experiences:
Enrich and support the curriculum
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Strongly Support
Limited or No Support
Not Applicable
Stimulate growth in knowledge, literary appreciation, aesthetic value, and ethical standards
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Strongly Support
Limited or No Support
Not Applicable
Provide background information to enable students to make intelligent judgements
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Strongly Support
Limited or No Support
Not Applicable
Present opposing sides of controversial issues
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Strongly Support
Limited or No Support
Not Applicable
Be representative of the many religious, ethnic, and cultural groups and their contributions to our American heritage
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Strongly Support
Limited or No Support
Not Applicable
Depict in an accurate and unbiased way the cultural diversity and pluralistic nature of American society
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Strongly Support
Limited or No Support
Not Applicable
Explanation of support for learning experiences:
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Provide further explanation of how this text will support the learning experiences listed above.
Explain the curricular objectives, standards, and benchmarks to be taught with this text:
Check all methods of instruction to be used with this text:
Whole-class direct instruction
Small-group direct instruction
Individual student choice
List the names of other staff/parents who have read/reviewed this text and recommend it for classroom use
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Must have at least 2 names listed, and one must be the department chairperson
Number of text to be purchased
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What method of payment will be used for purchase of this text:
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Select all methods that apply
Text in district but not on approved list for use
Building budget (pending administrator approval)
District Curriculum funds (pending Superintendent approval)
Other funding (Grant, PTO, other)
Teacher Book order points (No funding necessary)
Select all methods that apply
Additional Information
My Principal is aware of and in support of this request for approval
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Sign This Form
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This field is your Digital Signature
Email Address
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