Complaint on materials
To the person requesting reconsideration: Library policy requires that complaints be filed on this form so that the complaint can be discussed in detail. Copies of the library's materials selection policy and other documents bearing on this complaint will be made available to you.
Title of book or material
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Author or source
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Publisher or product
Request initiated by
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First Name
Last Name
Requester represents:
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Individual
Organization
Name of organization (if applicable)
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Specifically, to what do you object? (Cite pages, instances, etc.)
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What do you think might be the result of reading, hearing, or viewing this material?
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What do you see as good about this material?
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Did you read the entire book or examine the entire item?
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Yes
No
Or what parts?
Are you aware of the judgment of this material by professional critics?
Yes
No
What do you believe is the theme of this book or material?
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What would you like the library do about this material?
*
Today's Date
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-
Month
-
Day
Year
Date
Signature
Submit Feedback
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