Adair-Casey School Library

Request for Reconsideration of Library Materials Form

The Adair-Casey Board of Education has authorized the use of this form in accordance with its Collection Development Policy and Challenged Materials Policy. The completed form should be returned to the library media specialist or the principal. Title: ____________________________________________________________ Author: ______________________________ Publisher: __________________ Format: ___ Book ___ Video ___ Digital Resource ___ Magazine ___ Audio Recording ___ Library Program ___ Newspaper ___ Display ___ Textbook

___ Other _______________________________________________________

Name: _________________________________

Date: ________________

Address: ________________________________________________________ City: ___________________________ State: ____ Zip Code: ____________ Phone: _________________ Email: __________________________________ I represent: Myself ____ Organization ____ Name of organization: _____________________________________________

Adapted from Haverford Township Free Library (2013) http://www.haverfordlibrary.org and Fergus Falls Public Library (2012) http://www.fergusfalls.lib.mn.us

Adair-Casey School Library

Request for Reconsideration of Library Materials Form
1. To what in the work to you object? Please be specific and cite page numbers, if applicable.

2. What brought this resource to your attention?

3. Have you examined the entire resource? If not, which parts did you read, view, hear, etc.?

4. What concerns do you have about this resource?

5. Are there resources that you would recommend that provide additional information or other viewpoints on this topic?

Adapted from Haverford Township Free Library (2013) http://www.haverfordlibrary.org and Fergus Falls Public Library (2012) http://www.fergusfalls.lib.mn.us