Request for Reconsideration of Instructional Resources
You may wish to review the MGSD School Board policies related to the Selection of Instructional Materials ( and Parental Inspection of an Objection to Instructional Materials (
Email *
Date *
Name of person making request *
Phone Number *
Address *
Complainant represents *
himself/herself or organization
Name of Organization if applicable
Are you a parent of guardian of a student in this school? *
Child's Grade Level
if applicable
School which owns the item to be reconsidered *
Mooresville Graded School District
Title of Item *
to be reconsidered
Format of Item
book, video, digital resource, ie.
Author, Artist, Composer *
Copyright Date
How did you acquire this item? *
Did you read, view, or listen to the entire item? *
If No, what parts did you review?
Is this item part of a series or set? *
If Yes, did you examine other items in the series or set?
Which items?
To what in the item do you object? *
(Please be specific: cite pages, frames, etc.)
What do you feel might be the result of a student's reading, viewing, or listening to this item? *
Are you aware of any evaluations of this item by authoritative sources? *
If Yes, did those sources agree with your opinion?
Please list the sources
Do you want other persons in the community to determine the kind of materials your child may or may not use in school? *
Other Comments
Once you are contacted by the school you may be asked to come in and sign your formal complaint *
Will this be an issue for you?
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This form was created inside of Report Abuse