Citizens Request for Reconsideration of Print Material
Date: _________________________
Author: __________________ Book _______
Magazine___Other_______
Title:
______________________________________________________
Publisher (if known)
___________________________________________
Your name:
__________________________________________________
Telephone: _______________________ Address:
____________________
City: _____________________ Zip Code: _________________
You represent:
____ Self
____Name of group or organization ________________________
(If objection is to material other than a book, change wording
of the following questions so that they apply.)
1. To what in this item do you object: (Please be
specific) ____________________________________________________________
2. What do you feel might be the result of reading this
material? ____________________________________________________________
3. For what age group would you recommend this item:
_________________
4. Did you read the entire piece? __________What parts?
_______________
5. Is there anything good about it?
_________________________________
6. Are you aware of the judgement of this material by
critics? _____________
7. What do you believe is the theme of this material?
____________________________________________________________
8. What brought this item to your attention?
__________________________
9. What would you like the Library to do about this
material? ____________________________________________________________
10. In its place, what item of similar content would you
recommend? ____________________________________________________________
11. Have you read the Lorain Public Library System
Materials Selection Policy as stated on the other side of this form?
______________________
____________________________
Your Signature
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Staff person taking request _____________________________
Comments:
_________________________________________________________
_________________________________________________________
Database # ________________