• Challenged Materials


    Challenged Materials

    CITIZENS REQUEST FORM FOR RE-EVALUATION OF MATERIALS 

    Initiated by___________________________________________________________________ 

    Address______________________________________________________________________

    Telephone______________________ Representing: Self?_________ Organization?__________________

    School where materials are used____________________________

    Grade level used________________________________________

    Author of the material in question____________________________

    Title__________________________________________________

    Copyright date__________________________________________

    Publisher______________________________________________

    AV Materials; Kind of media_____________________________________________________________

    (film, filmstrip, record, etc.)

    Other materials or presentation; identify____________________________________________________

    Please respond to the following questions. If sufficient space is not available, please use back of this sheet or additional sheet of paper.

    1. Have you read, seen, viewed, listened to this material in its entirety? 

    2. What do you believe is the main idea of this material?

    3. To what do you object? Please cite specific passages, pages, sequences, etc.

    4. What do you feel might result from use of this material?

    5. Are you aware of reviews of this material? What reviews have you read? 

    6. Was the material required?____________________ Recommended?______________________________ 

    By whom_______________________________________________________________________________

    7. For what grade level might this be suitable? 

    8. What action would you prefer that the school take on this material? 

    a. Do not assign it to my child

    b. Other _______________________________________________________________________________

    9. In its place, what material do you recommend which would provide adequate information on the subject or as a valuable picture and perspective of our society?

    Date_____________________ Signature_____________________________________________