REQUEST FOR RECONSIDERATION OF LIBRARY MATERIAL

MEDIUM (Book, video, etc.) _____________________________________________________ Author _______________________________________________________________________ Title _________________________________________________________________________ Publisher ______________________________________________________________________ Copyright date ________  Call number _________________ Hard Cover _____ Paper back _____

NAME OF SCHOOL BUILDING WITH THE TITLE IN THE SCHOOL LIBRARY MEDIA COLLECTION

REVIEW REQUEST INITIATED BY Name (print) __________________________ Signature ________________________________ Address ______________________________________________________________________ City ____________________________________ State __________________  Zip __________ Home Phone ____________________ Business Phone __________________ Ext. ___________

COMPLAINANT REPRESENTS  Himself / herself   yes ______  no _____                 Other individual or group   yes _____ no _____ If representing other(s) give name of persons (s), addres(s) and phone number(s).

EVALUATION  (attach extra pages as needed) 1.  I have read or viewed the entire book, video etc.  yes _____ no _____ 2.  Summary of the book in own words     3.  To what in the book do you object?  Please be specific and cite page numbers. 4.   What do you feel might be the result of reading this book?  Please be specific and cite pages?     5.  What do you like or find positive about this book?  Please be specific? 6.  Is there any age or group that should be allowed access to this book?  If yes, who or what group?  Please be specific and explain your reasoning.   7.  Is there any age or group that should not be allowed access to this book?  If so, who or what group?  Please be specific and explain your reasoning.     8.  Have you read any reviews of the material and if so, please list source and date of the review.     9.  Are you aware of the literary critics judgment of this book and the authors reputation?  Write what you know of these literary opinions.     10.  What would you like the school to do about this book?     11.  Can you recommend another title for the school library to purchase which presents an alternative point of view from the title in question.  If yes please list title, author, publisher, copyright.