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Request for Reconsideration of Library Material Form

Your name:         ________________________________________________________________________

Address:              ________________________________________________________________________

Telephone:         ___________________                 E-mail: _______________________________________

 

Title:      ______________________________________________________________________________

Author:                 _______________________________________________________________________

Publisher:            _______________________________________________________________________

Date:     ___________________________________

  • Did you read, listen to, or view the entire material?  (circle one)                  Yes         No

 

  • If “no”, which parts did you read, listen to, or view?        

 

 

  • What passages did you find objectionable?

 

 

  • To whom do you feel this material would be unacceptable?

 

 

  • If this material were to remain in the library, what would the effect be?

 

 

__________________________________________________     ________________________________

Signature                                                                                                            Date

 

Approval Date:  May 2013

Amended: February 2016, February 2017

Revision/Review Date: February 2020

Approval Signature: original signed by Board Chair: Elizabeth Luck