Code: IJLA-E CITIZEN'S REQUEST FOR RECONSIDERATION OF A BOOK OR OTHER MATERIAL
PLEASE ANSWER ALL THE QUESTIONS. USE REVERSE SIDE IF NECESSARY.
Title of Book, Film, Article, Etc. ______________________________
Author___________________ Hardcover___________ Paperback_________
Request initiated by__________________________ Date______________
Address__________________________________ Telephone______________
Complainant represents: ________ Himself ________ Name of Organization ________ (Identify Other Group)
To what in the material do you object? (Please be specific -- cite pages).
What do you feel might be the result of exposure to this material?
For what age group would you recommend this material? ___________ Is there anything good about this material?____________________________________ Have you inspected all the material?_______ Did you read the entire book? ______________________________________________________________________ Did you view the entire film? _______________________________________________ Are you aware of the judgment of this material by literary critics? ________________ ______________________________________________________________________ What do you believe is the theme of this material? _____________________________________ ________________________________ What would you like your school to do about this material? ______________________________________________________________________
____ Do not assign it to my student. ____ Withdraw it from all students as well as from my student. ____ Have its place within the curriculum reviewed. In its place, what material of equal literary or scholarly value would you recommend? ____________________________________________
RETURN COMPLETED FORM TO: Superintendent of Schools Signed __________________________ _____________________________ Adoption Date: 9/19/17 |
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