<--Begin Google Analytics Tracking Code--> <--End Google Analytics Tracking Code-->

Citizen Request for Reconsideration of Library Materials



Title of Work: _______________________________________________


Author: ____________________________________________________


Publication Date: _________________  Format: ____________________


Request Initiated by:___________________________________________


Phone: ____________________





Complainant represents: ______his/herself


                                        ______organization (listed below)






What do you find objectionable about the above listed material?  Please be specific.





What do you feel might be the result of borrowing this item from the library?





Is there anything good about this item?








Did you read/view the entire item?  If not, what parts?






What do you think is the theme of this item?






What item would you recommend to take the place of the above challenged item?







_______________________________________                  ____________________

Signature of Complainant                                                          Date








Received by:



_______________________________________                  ____________________

Signature of Staff   member                                                        Date