JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
School Library Media Center Materials Challenge Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Challenger's Name
Your answer
Challenger's Email
Your answer
Challenger's Address
Your answer
Challenger's phone number
Your answer
Challenger's Zone School
Your answer
Author of the material
Your answer
Print or Nonprint
Print
Nonprint
Clear selection
Title of Material
Your answer
Publisher (if known)
Your answer
Request initiated by
Your answer
To what in the material do you object (please be specific site section or pages)
Your answer
What do you feel might be the result of reading/viewing/listening to this material?
Your answer
For what age group would you recommend this material?
Your answer
Did you read/view/listen to the entire material?
yes
no
Clear selection
What did you find acceptable about this material?
Your answer
Are you aware of the judgement of this material by qualified critics or review sources?
yes
no
Clear selection
If you answered (yes) please give citation.
Your answer
What do you believe to be the theme of this material?
Your answer
What would you like your school to do about this material?
Do not assign it to my child
Place material at another school level
Withdraw it from all students
other
Clear selection
In it's place, what material of equal quality would you recommend?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Atlanta Public Schools.
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report
