Patron Request for Reconsideration of Library Materials

Patron Request for Reconsideration of Library Materials
Title: _______________________________________ Author:______________________________
Copyright Date:___________ ISBN (a staff member can help with this): ____________________________
Date Received by the staff: ________________________ Staff Initials: _____________
Book DVD Audio book/Music CD Magazine/Newspaper Internet Site Art Other
Requested by: _____________________________ Signature: ______________________________
Mailing address: ___________________________________________________________________
Mattoon, IL 61938
City: ______________________ , IL Zip Code: _____________
Telephone: ( ____) ____________________
Representing: _ Self _Organization
Organization address: _________________________________________
City: __________________ Phone: ( ) _________________
What specifically concerns you about this material? Please be specific and cite pages.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Did you read/listen to the entire item? If no, what parts?
________________________________________________________________________________
What do you believe is the central theme of this material?
________________________________________________________________________________
Is there any age group for which this material might be appropriate? If so, please specify.
________________________________________________________________________________
Are there, in your judgment, any positive elements in this material? Please describe.
________________________________________________________________________________
________________________________________________________________________________
Are you aware of any literary reviews of this material? (If so, please cite.)
________________________________________________________________________________
What material(s) can you suggest to counterbalance the point of view of this material or provide
additional information on the Subject?
________________________________________________________________________________
________________________________________________________________________________
Please feel free to add additional sheets if necessary.
Approved 11/3/08
H:\Policies Procedures\Patron Request for Reconsideration of Library Materials.doc