Citizen’s Request for Reconsideration on an Item

Item:_____________________________________________________________________

Request initiated by:_______________________________________________________

Telephone: __________________Address: ________________________City:_________

Complainant Represents: ______________________________________________(Self)

(Name of Organization)____________________________________________________

(Identify other Group)_____________________________________________________

To what do you object?____________________________________________________

__________________________________________________________________________

What do you feel might be the result of using the item?__________________________

____________________________________________________________________________

For what age would you recommend this item?_________________________________

Did you review the entire item?______________________________________________

Are you aware of the judgment of this item by literary critics?_____________________

What do you believe is the theme of this item?__________________________________

What would you like your Library to do about this item?_________________________


What item of equal quality would you recommend be substituted in its place?________


Signature of complainant: ___________________________________Date: __________

Exhibit 1