Sample - Request for Reconsideration of Library Resources

The __________ Library has delegated responsibility for selection and evaluation of library resources to___________ (director, selection committee, etc.) and has established reconsideration procedures to address concerns about those resources. Completion of this form is the first step in those procedures. If you wish to request reconsideration of library resources, please return the completed form to __________.

Name ___________   Date ___________
Address ___________   City ___________
State ___________   Zip ___________
Phone ___________      

Do you represent:[ ] self? [ ] organization?

Resource on which you are commenting:

[ ] book [ ] textbook [ ] video display [ ] magazine [ ] audio [ ] recording [ ] newspaper [ ] library program [ ] electronic information/network (please specify) ___________

Other ___________

Title ___________

Author/Producer ___________

What brought this resource to your attention?

Have you examined the entire resource?

What concerns you about the resource? (Use back or additional paper if needed.)

What resources do you suggest to provide additional or other viewpoints on this topic?