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Citizen Request for Reconsideration of Library Materials

 

 

Title of Work: _______________________________________________

 

Author: ____________________________________________________

 

Publication Date: _________________  Format: ____________________

 

Request Initiated by:___________________________________________

 

Phone: ____________________

 

Address:____________________________________________________

 

 

Complainant represents: ______his/herself

 

                                        ______organization (listed below)

 

                                        _______________________________________

 

 

 

What do you find objectionable about the above listed material?  Please be specific.

 

 

 

 

What do you feel might be the result of borrowing this item from the library?

 

 

 

 

Is there anything good about this item?

 

 

 

 

 

 

 

Did you read/view the entire item?  If not, what parts?

 

 

 

 

 

What do you think is the theme of this item?

 

 

 

 

 

What item would you recommend to take the place of the above challenged item?

 

 

 

 

 

 

_______________________________________                  ____________________

Signature of Complainant                                                          Date

 

 

 

 

 

 

 

Received by:

 

 

_______________________________________                  ____________________

Signature of Staff   member                                                        Date