Request for Reconsideration of Library Materials

Request for Reconsideration of Library Materials
Name

First NameLast Name
Address

Street Address

Street Address Line 2

City in Michigan

Zip Code
Daytime Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Library Location of Material to be Reconsidered
Call Number of Item (Located on spine of item)
Author
Title
Format of Item (please check)

Other
Please answer the following questions about the material:
What do you find objectionable and/or offensive about this item? Please give specific examples.
Please list the specific page numbers or section of any part that you find objectionable or offensive.
Have you read (or listened to/viewed) the item in its entirety? If not, what pages or sections have you read (or listened to/viewed)?
Have you read any critical reviews of this item? If yes, please include source.
Do you recommend that the library:
Do you have a recommendation for an alternative to this item?
By signing this document, I affirm that the above information is true and accurate to the best of my knowledge.

The Ypsilanti District Library thanks you for your interest in the library's collection. You will receive written notification of the decision regarding your request.
Signature (draw with your mobile device or mouse)
Today's Date

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Date
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Please answer the following questions about the material: