Appendix D: Request for Reconsideration of Library Materials

Fulton County Public Library

Please fill out this form as completely as possible & send to the Director’s office when completed)
Received by Director ________________

Title: _____________________________________________________________________

Author: ______________________________________ Publisher: ____________________

Book __ Periodical __ Video __ Cassette __ CD __ CD-ROM __ Book on Tape __ Other __

Your Name: __________________________________________________________

Address: _____________________________________________________________

City ______________________ State _______ Zip: __________ Phone: _______________

Do you represent: Yourself ______

An organization ______ (name) _________________________________________________

Another group ______ (name) _________________________________________________

1. To what in the work do you object? (Please be specific and cite pages where possible) _____ ___________________________________________________________________________ ___________________________________________________________________________

2. Did you read/view/listen to the entire work? _______ If not, which parts? ______________ ___________________________________________________________________________ ___________________________________________________________________________

3. What do you feel might be the result of reading/viewing/listening to this material? _________ ___________________________________________________________________________

4. For what age group would you recommend this material? ____________________________

5. What do you believe is the theme of this material? __________________________________ ___________________________________________________________________________ ___________________________________________________________________________

6. Are you aware of any judgements of this work by literary or other established critics? ______ ___________________________________________________________________________

7. What would you like the library to do with this material? Please explain. ________________ ___________________________________________________________________________ ___________________________________________________________________________

8. In its place, what material would you recommend which would convey as valuable a picture and

perspective of the subject treated? ____________________________________________ ___________________________________________________________________________

Signature: __________________________ Date: _________ Received by: ________

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