1
Request for Reconsideration of Library Materials
Title__________________________________________________________________
[ ] Book
[ ] Periodical
[ ] Other
Author________________________________________________________________
Publisher______________________________________________________________
Request initiated by______________________________________________________
Address_______________________________________________________________
City___________________________ State____________ Zip code_____________
Phone_________________________ Email _________________________________
Do you represent:
[ ] Yourself
[ ] An organization/group
(name)________________________________________
1.
Do you have a child enrolled at Falk School?
Name ___________________________________ What grade or level? ______
2.
To what in the work do you object? (Please be specific. Cite pages).__________
________________________________________________________________
________________________________________________________________
3.
Did you read the entire work?______ What parts?________________________
________________________________________________________________
4.
What do you feel might be the result of reading this work? _________________
________________________________________________________________
5.
For what age group would you recommend this work?_____________________
6.
What do you believe is the theme of this work? __________________________
________________________________________________________________
7.
Are you aware of judgments of this work by literary critics? _________________
ReconsiderationForm.doc
8/1/2010
2
8.
What would you like the library to do about this work?
[ ]
Do not lend it to my child.
[ ]
Return it to the staff selection committee for reevaluation.
[ ]
Other
Explain:_________________________________________________________
________________________________________________________________
9.
What replacement would you recommend which would fulfill the same purpose as the
material to which you object?
________________________________________________________________
________________________________________________________________
________________________________________________________________
Signature________________________________________
Date____________________________________________
ReconsiderationForm.doc
8/1/2010