Neb. Admin. Code EDUCATION, DEPARTMENT OF, tit. 92, ch. 4, app A
NDE # 22-001
Revised effective (date to be inserted later)
DATE DUE: 1/15
(one application form per student)
TO: ____________________________________________________________________
(Board of education or school board of the school district in which the student requesting the loan resides or in which the private school the child attends is located.)
Application is hereby made, pursuant to Neb. Rev. Stat, 79-734(2) and the rules and regulations promulgated thereunder, that you loan my child or ward the following textbook(s), by title, which are designated for use in your school district*:
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My child or ward is a student at________________________________________________
which is a private school approved for continued legal operation under Title 92, Nebraska Administrative Code (NAC), Chapter 14, or accredited under Title 92, NAC, Chapter 10.
My child's or ward's name is___________________________________________________.
He or she will be in the________grade beginning in the fall of the next school year, and resides at___________________________________________________________________.
________ ___________________________________________________
DATE PRINT NAME OF PARENT OR GUARDIAN
(DESIGNATE WHICH)
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SIGNATURE OF PARENT OR GUARDIAN
_________________________________________
ADDRESS OF PARENT OR GUARDIAN
_________________________________________
_________________________________________
PHONE NUMBER OF PARENT OR GUARDIAN
*NOTE: Per Section 003.03, the school district shall limit the loan each year to ten textbooks per student for students in grades K-6 and to eight textbooks per student for students in grades 7-12.
(This application must be received by the public school district no later than January 15.)
Neb. Admin. Code EDUCATION, DEPARTMENT OF, tit. 92, ch. 4, app A