REQUEST FOR RECONSIDERATION OF EDUCATIONAL MEDIA

Name of Complainant_________________________________________________

Address____________________________________________________________

Occupation_________________________________________________________

Kind of Media_______________________________________________________

Title__________________________Author or Producer_____________________

Reason for objection (cite particular sequences and approximate location in media)

Specific Objections: _________________________________________________

__________________________________________________________________

__________________________________________________________________

Any merits noted in this media:  ________________________________________

__________________________________________________________________

__________________________________________________________________

Have you read, viewed, and/or auditioned the entire material to which you object?

__________________

Have you read, viewed, and/or auditioned other media by the author or producer?

__________________

List titles previously examined:  ________________________________________

__________________________________________________________________

What material on the same subject would you recommend for replacement?

Title________________________Author or Producer_____________________

Copyright Date______________________

Is your alternate selection in our library media center?_______________________

Signature________________________________