Materials Reconsideration Form

TITLE ________________________________________________________________________________

AUTHOR ______________________________________________________________________________

PLEASE CHECK ONE:  _____ BOOK  _____ PERIODICAL  _____ A/V (SPECIFY)

 ________________________                             _____ ELECTRONIC MATERIALS

PUBLISHER _________________________________________________________________________ 

DATE OF PUBLICATION ________________________________________________________________

REQUEST INITIATED BY: ________________________________________________________________

ADDRESS _____________________________________________________________________________

CITY ______________________________________________  STATE ________  ZIP ________________

PHONE __________________________________________

DO YOU REPRESENT:  _____ YOURSELF _____ AN ORGANIZATION (NAME)

___________________________________________________________________________________

OTHER GROUP (NAME) ______________________________________________________________

1.   To what in the work do you object?  (Please be specific. Cite Pages.)

_____________________________________________________________________________________

2.   Did you read the entire work? __________ If not, what parts did you read?

______________________________________________________________________________________

3.   What do you feel might be the result of reading this work?

______________________________________________________________________________________

4.   For what age group would you recommend this work?

 ______________________________________________________________________________________

5.   What do you believe is the theme of this work?

________________________________________________________________________________________

6.   Are you aware of judgments of this work by literary critics? ____________________________________

7.   What would you like your Library to do about this work? _______ Do not lend it to my child.

_____ Return it to the staff selection committee of reevaluation.  ______ Other (Please explain)

________________________________________________________________________________________

8.   In its place, what work would you recommend that would convey as valuable a picture and perspective of the subject treated?

________________________________________________________________________________________

(Please use other side for additional comments.)

Signature _________________________________________  Date ______________

Received By _______________________________________ Date_______________ 

Passed 02/27/03