Request Form for Reconsideration of Materials

Author:
Title:
Publisher:
Copy Right Date:
Call Number of Item:
Format (i.e., hardcover or paperback, audio on CD, DVD, etc.)
Review request initiated by Name:
Address
City:
Untitled
State:
Zip Code:
Home Phone:
Business Phone and Ext.
Complainant Represents:
Himself/Herself
Complainant Represents:
Other than himself/herself
Complainant Represents:

If the Complainant is not yourself, give name of group &/or person, Address for Group &/or person, City, State, Zip code, and Phone number of group &/or person and Ext.
Have you read the entire book?
If yes, give a summary of the book in your own words.
To what in the book do you object? Please be specific and cite pages.
What do you feel might be the result of reading this book? Please be specific and cite pages.
What do you like or find positive about this book? Please be specific.
Is there any age or group that should be allowed access to this book? If yes, who or what group? Please be specific and explain your reasoning.
Is there any age or group that should not be allowed access to this book? If so, who or what group? Please be specific and explain your reasoning.
Have you read any review of the material?
If yes, please write the source of the review(s) and the date(s) below:

Source of Review(s) Date of Sources(s)
Are you aware of the judgment of this book and/or of this author by literary critics? Write what you know about these literary opinions.
What would you like the Frost Free Library to do about this book?
Can you recommend another title for the Library to purchase to present the opposite, or an alternative, point of view of the title in question?
If the above was answered yes, please give the following information:

Author: Title: Publisher: Copy Right Date: ISBN: Review Source: Date: Page(s): Signature: Date: Received by: Staff Member Name: Date:
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