REQUEST FOR RECONSIDERATION OF LIBRARY MATERIAL

Type of Material _______________________________________________________________

Title _________________________________________________________________________

Author/Editor __________________________________________________________________

Publisher (if known) ____________________________________________________________

Request initiated by _____________________________________________________________

Library Card # _________________________________________________________________

Address ______________________________________________________________________

City _______________________________  State ____________ Zip  _____________________

Telephone _______________________________________

Complainant represents:

____________ Self

____________ (Name of Organization) _____________________________________________

____________ (other) ___________________________________________________________

1. To what in the material do you object? (Please be specific; cite pages.)

2. Did you read, listen to, or view the entire material? __________ If no, what parts?

3. In your opinion, is there anything good about the material? ________________________

4. What action do you suggest the library take regarding this material? _________________

5. Can you suggest another item to take this one’s place? ____________________________

Complainant’s signature __________________________________  Date __________________