Request for Reconsideration of Instructional Materials
This form will be used to file a grievance on a certain book or material located in the Fairbury Jr/Sr High School Media Center. Please be specific and professional in your responses, and the Library Media Specialist will respond to your request within two weeks time of the grievance being submitted.
Your name: *
Your answer
Author of the Material: *
Your answer
Title of the Material: *
Your answer
Publisher (if known)
Your answer
Your Telephone #: *
Your answer
Your Address: *
Your answer
Complainant Represents: *
To what in the book do you object? (Please be specific with page numbers and text) *
Your answer
What do you feel might be the result of a student reading this book? *
Your answer
For what age group do you feel this book should be? *
Your answer
Do you see any good things about this book that would be a reason to keep it in our collection? *
Your answer
Have you read the entire book? If not, what parts? *
Your answer
Have you researched the judgment of this book by professional literary critics? If so what have you found? *
Your answer
What action would you recommend is taken by the district concerning this material? *
If the book were to be removed, please suggest a book of equal literary quality that you would rather see in our collection to better represent our community. *
Your answer
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