Name: E-mail Address: School: Full School Address: School Phone Number:
What Do You Want to Borrow?
Watershed Activity Module...	Additional Loaner Equipment...
Aquatic Macroinvertebrate Module Basic Water Chemistry Module Drinking Water Module Freshwater Fish Module Groundwater Module Riparian Buffers Module Stream Geology Module Streamside Critters Module Topographic Map Module Water Pollution Module Watersheds Module Wetlands Module Freshwater Mussels & Gastropods (Mini Module) Algae, Plankton & Aquatic Plants(Mini Module) Reptiles & Amphibians (Mini Module)	Hach Kits: Alkalinity How many alkalinity kits? 1 2 3 4 Dissolved Oxygen How many DO kits? 1 2 3 4 Ferrous Iron How many Fe kits? 1 2 3 4 Hardness How many hardness kits? 1 2 3 4 Nitrate-Nitrogen How many N kits? 1 2 3 4 pH How many pH kits? 1 2 3 4 Sulfates How many sulfate kits? 1 2 3 4 Total Phosphorous How many P kits? 1 2 3 4 Turbidity How many turbidity kits? 1 2 3 4 Interactive PowerPoint Presentations: Aquatic Macroinvertebrates Riparian Buffers 101 Water Pollution in Pennsylvania and the U.S. What is a Watershed? What is a Wetland? Other Loaner Equipment: 12 GPS Units Microscope Video Camera and Monitor
Please check module availability before selecting dates. Date Wanted:  Choose month January February March April May June September October November December Choose date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Return Date: Choose month January February March April May June September October November December Choose date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 *Modules can only be loaned out for a maximum of three weeks. If available, we will try to deliver the modules at your requested date. Will any other teacher be using this equipment during the time?  Yes  No If yes, please give name:  Additional Comments: