Certificate of Individual Request for Loan of Instructional Materials
To: Secretary of Education Department of Education Box 911 Harrisburg, Pennsylvania 17126
I hereby request the loans of instructional materials in accordance with Act 90 of 1975, for my child(ren) attending (Name of School)
__________________________________________
in Borough, City, Town, County).
___________________
Signed
___________________________________________
Parent, Guardian
Date
___________________________________________
Pennsylvania Department of Education Act.
School year
__________
(to be updated annually)
22 Pa. Code § 115.23