Patron request for reevaluation of library materials

Please take time to complete the following form to help us understand your concerns. It is important for you to provide contact information, so that we may follow-up with you.

Contact information

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you representing:

Self

Organization or group

If representing an organization or group, please identify:

Material

Title

Publisher

Date

Enter the date the book was published

Additional required information

How did you learn about the material in question?

How much of this material did you read and/or examine?

Have you read any reviews of the material?

Yes

If yes, please indicate the name of the reviewer and/or the publication in which it appeared.

What do you believe is the theme of the material?

What specifically is objectionable about the material? Please be specific and cite pages.

What do you feel might be the result of reading, seeing or listening to this material?

Is it suitable for some age groups?

Is there anything worthwhile in the material?

What would you like for us to do about this material?

What substitute would you recommend to replace the material?

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Phone

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