Request for Review of Library Materials

 

Author                                                                                                                                                                                              

 

Title___________________________________________________________________________________

 

Publisher/Producer________________________________________________________________________

 

Request initiated by__   ____________________________________________________________________

 

Telephone Number                                       Address_________________________________________________

 

City                                                                    Zip Code                                                                                                               

 

Complainant represent:

 

     Himself/herself

 

     Organization__________________________________________________________________________

 

    Identify other group____________________________________________________________________  

 

1.             To what, in the material, do you object?  Please be specific.

 

_________________________________________________________________________________________  

2.             What do you feel might be the result of the reading or viewing of the material?

 

                                                                                                                                                                                                               

3.             For what age group would you recommend the material?

 

                                                                                                                                                                                                              

4.             Did you read or view the entire work?            What parts?

 

_________________________________________________________________________________________

5.             Are you aware of the judgment of the material by reviewers or evaluators?

 

                                                                                                                                                                                                               

6.             What do you believe is the theme of the material?

 

                                                                                                                                                                                                               

7.             What would you like the library to do about the material?

 

                                                                                                                                                                                                               

 

                                                     __________________________________________________________________

Date                                                                                        Signature of Complainant

 

 

Reviewed:        12/8/97

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