CITIZEN'S REQUEST FOR RECONSIDERATION OF
LIBRARY OR CLASSROOM MATERIALS
(Please fill in the appropriate blanks)
Title Book p Periodical p Other p
Author/Producer
Publisher/Distributor
Address
City/State/Zip Telephone
Do you represent: Yourself p
An Organization p (Name )
1. To what in the work do you object? (Please be specific.)
2. Did you read, view or listen to the entire work? If not, what part or parts?
3. What do you feel might be the result of reading, viewing, or listening to this work?
4. For what age group would you recommend this work?
5. What do you believe is the theme of this work?
6. Are you aware of professional reviews of this work?
7. What would you like the school to do about the work?
8. In its place, what work would you recommend that would convey as valuable a picture and perspective of the subject treated?
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Signature
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Date
Additional Comments (use other side if necessary):
Adoption Date: April 8, 1993