Request for Reconsideration of Library Material form

Title

Author/producer

Publisher

Type of material (format/genre)

Have you examined the material in its entirety?

Yes
No

What did you find objectionable? (Be specific, including page number)

What harm do you feel will result from its use?

Did you find anything valuable in this material?

What do you think is the author's/director's purpose?

Do you know of any material that would better suit this purpose?

Would this material be better suited for a different age level?

Yes
No

If yes, please select all that apply

Adults
Teens
Children

What action do you feel should be taken on this material?

Woud you be willing to discuss this material with the Director and the Library Board of Trustees?

Yes
No

Your request will be carefully considered. You will receive a written response concerning the status of the item under reconsideration. You may appeal the decision of the Director to the Library Board of Trustees.

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Do you represent:

yourself
an organization

Organization name

Your Library

Services