REQUEST FOR RECONSIDERATION OF LIBRARY MATERIALS
Author____________________________________________________________________
Title______________________________________________________________________
Publisher _________________________________________________________
Requestor’s Name__________________________________________________________
Telephone________________ Library Card Number: _____________________________
Address____________________________________________________
City__________________ State _____ Zip____________________________
If representing an organization, name of organization: _____________________________
______ I have read/viewed/listened to the item in its entirety.
What do you believe is the theme of this item?_________________________________________________________________
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To what in the item do you object? Please be specific. Cite pages or scenes: _________________________________________
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What harmful effect do you feel might be/was the result of reading/viewing/listening to this item?
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Do you believe this item serves any of the following purposes?
Promotes understanding of other cultures and of lifestyles? ___Yes ___No
Promotes discussion of societal issues? ___Yes ___No
Provides information about a subject unavailable from another source? ___Yes ___No
In its place, what item of equal quality would you recommend that would convey as valuable a picture and perspectives?
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Signature of Requestor___________________________________ Date_______________
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