JointSchool District #2
DEPARTMENT OF STUDENT ACHIEVEMENT
SCIENCE KIT REFURBISHMENT REQUEST FORM
SixthGrade –Science
Page 1 of 4
Please send form to Joe Kelly/Jill Whalen at the Curriculum Office or fax to 350-5959 or send as email to or
Date Requested:Date Needed:
Requested By:School:
Sixth Grade –ScienceItem Requested / Amount Requested / Amount Sent
Aluminum Foil
Bag, Plastic (6” x 10”)
Bag, Plastic (grocery)
Baking Soda (454 g)
Balloon, Round (7”)
Balloon, Round (13”)
Balloon, Round (15”)
Battery, D-Cell
Beans, Mixed
Bean Seed, Sprouted
Bottle, Plastic (2-L)
Bottle, Plastic (0.5-L)
Box, Cardboard (12 cm x 12 cm x 12 cm)
Bubble Wrap
Cardboard, Corrugated (15 cm x 15 cm)
Clay, Modeling (4 colors)
Clay, Modeling (brown)
Clay, Modeling (cream)
Clay, Modeling (green)
Clay, Modeling (red)
Clay, Modeling (yellow)
Coffee Filter
Confetti
Conifer Cone
Conifer Needle
Container, Sandwich
Cotton
Craft Stick
Cup, Paper (6 oz)
Cup, Plastic (16 oz)
JointSchool District #2
DEPARTMENT OF STUDENT ACHIEVEMENT
SCIENCE KIT REFURBISHMENT REQUEST FORM
Sixth Grade – Science
Page 2 of 4
Please send form to Joe Kelly/Jill Whalen at the Curriculum Office or fax to 350-5959 or send as email to or
Date Requested:Date Needed:
Requested By:School:
Sixth Grade – ScienceItem Requested / Amount Requested / Amount Sent
Cup, Plastic (300 ml)
Cup, Plastic Foam (6 oz)
Duckweed
Elodea
Fabric
Foam Peanut
Food Coloring, Blue
Food Coloring, Red
Gelatin, Lemon-Flavored (pkg/4)
Grapes
Graphite, Specimen Pack
Gravel, Aquarium (2.5 kg)
Gravel, Large
Gravel (1 kg)
Household Solution Set
Ice Cubes
Index Card
Index Card (3” x 5”)
Iron Filings
Jar, Glass with Lid (850 mL)
Knife, Plastic
Light Bulb
Light Stick, Unopened
Litmus Paper (Blue)
Litmus Paper (Red)
Marker
Marker, Permanent
Nail (9 cm)
Newspaper
JointSchool District #2
DEPARTMENT OF STUDENT ACHIEVEMENT
SCIENCE KIT REFURBISHMENT REQUEST FORM
Sixth Grade – Science
Page 3 of 4
Please send form to Joe Kelly/Jill Whalen at the Curriculum Office or fax to 350-5959 or send as email to or
Date Requested:Date Needed:
Requested By:School:
Sixth Grade – ScienceItem Requested / Amount Requested / Amount Sent
Owl Pellet
Pan, Aluminum
Paper
Paper, Construction
Paper, Graph
Paper, Wax
Paper Clip, Large
Paper Towel
Peanuts, Styrofoam Packing
Pebbles, Small
Pencil
Pencil, Colored
Pencil, Round
Petroleum Jelly (4 oz)
Plate, Paper
Pond Snail
Pond Water
Poster Board
Pushpin
Rubber Band
Salt
Salt, Non-Iodized
Salt, Rock
Sand, Coarse
Sand, Fine
Seeds, Lima Bean
Shells, Assorted
Soil, Clay (2.5 kg)
Soil, Potting (8 lb)
JointSchool District #2
DEPARTMENT OF STUDENT ACHIEVEMENT
SCIENCE KIT REFURBISHMENT REQUEST FORM
Sixth Grade – Science
Page 4 of 4
Please send form to Joe Kelly/Jill Whalen at the Curriculum Office or fax to 350-5959 or send as email to or
Date Requested:Date Needed:
Requested By:School:
Sixth Grade – ScienceItem Requested / Amount Requested / Amount Sent
Spoon, Plastic
Starch, Liquid (1 qt)
Straw, Plastic (wrapped)
Stirrer
String, Cotton (200’)
Sugar (454 g)
Sulfur, Specimen Pack
Tape
Tape, Duct
Tape, Masking
Tape, Packing
Tape, Transparent
Toothpicks
Twist Tie, Plastic
Vinegar (500 ml)
Warm Pack, Unopened
Wide-Range Indicator Paper
Wire, Copper (18 gauge)
Yarn, Red
Comments:
For Office Use Only:
Date Request Received:Date Items Sent:
Signed: