Instructions: Please read, watch, or listen to the entire book, magazine, video or sound recording you wish to discuss before completing this form. The library will not review objections to material you have not fully examined and considered carefully. This challenge will not be accepted or reviewed unless all questions have been answered and it has been signed. Use additional pages as desired. The completed report shall be submitted to the Library Director.
Name of person making request: ____________________________________________________________________
Address: _______________________________________________________________________________________
Phone: ________________________
Alternate phone: _______________________________
If representing an organization, please identify it: ________________________________________________________
Material you wish to discuss:
Author: ______________________________________________________
Title: ______________________________________________________
Format (book, video, sound recording, etc.): _____________________________
Have you read/viewed/heard this work in its entirety? ___________________________________________
Have you read the library’s Materials Selection Policy? ___________________________________________
What do you object to in this material? Please be specific and cite page numbers, scenes, or tracks.
What do you feel may be the result of reading/viewing/listening to this material?
Is there anything good about the material?
Have you read any reviews of this material? If so, please list the source of the review(s).
What would you recommend the library do with this material?
Could you recommend a better publication of this kind, or another title to present the opposite point of view in question?
Signature ___________________________________________________
Date _______________