REQUEST FOR RECONSIDERATION OF INSTRUCTIONAL AND LIBRARY MATERIALS BANNER COUNTY SCHOOL
Date ______________________
Name of Individual, Organization, or other Group Making Request. ________________________________________________________________________
Address ________________________________________
Telephone No. ____________
Material Being Considered Book:
Author _______________________________
Title ____________________
Publisher _____________________________
Copyright Date ___________
Non-Print Material: Type of Media (Film, Filmstrip, Record, etc.)
Title _________________________________
Producer _________________
Please respond to the following items. If space does not permit, please use the remaining space on the reverse side of this sheet.
I. Did you read or examine the material in its entirety? _______
II. Identify those parts or aspects to which you object. Cite specific pages, passages, or individual items. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
III. What do you believe is the theme or purpose of the content? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
IV. State the reasons for considering the material objectionable and what you feel would result from its use. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
V. For what age group do you feel this material is suitable? ______________________________________________________________________ ______________________________________________________________________
VI. Is there anything good about this material? (Please List) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
VII. What action do you recommend the school take on this material? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
VIII. As an alternate, what material, of acceptable quality, would you recommend to provide as a valuable picture and perspective of the subject as the item you question? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
Additional Comments:
_____________________________________ _____________________________________
