Request for Reconsideration of Material
Name:
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
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Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Email:
example@example.com
Library Card Barcode:
Home Library:
Whom do you represent?:
Yourself
Organization
Item information:
Book
Ebook
Movie
Magazine/Newspaper
Audio Recording
Display
Digital Resource
Game
Other (Specify Below)
Title:
Author/Artist/Producer:
Publisher:
Copyright Date:
What brought this material to your attention?
Did you personally read or view the entire item listed above? If not, please specify which parts you did.
What do you think is the theme of this material?
Why do you find the material objectionable? Be specific and include pages, tracks, or portions.
What do you feel may be the result of exposure to this material?
Despite your objections, does this item have literary, historical, or library value?
Please list any professional reviews you have read of this material.
Would you recommend that this material be available or unavailable for a particular age group?
Is there another work you would recommend in its place?
What action are you requesting the committee consider?
Signature:
Clear
Date:
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Month
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Day
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Date
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