Request for Reconsideration of an Item Form


See Reconsideration Policy and Procedures for an explanation of the use of this form.

Date __________________________

Title of Item ___________________________________________________________

Author/Artist ___________________________________________________________

Publisher ______________________________________________________________

Request initiated by ______________________________________________________

Address ________________________________________________________________

Telephone (Day) ________________________ (Evening) ________________________

Do you represent

__________ Yourself

__________ A Group or Organization – _______________________________________

Please help us understand your request by answering the following:

1. Why do you object to this item? Please be specific.

2. Did you read/view/listen to the entire item? ___________________ If not, what


3. What do you feel might be the result of reading/listening to/viewing this item?

4. Is there anything of value in this item?

5. What do you believe to be the theme of this item?

6. What review(s) of this item have you read or seen? (Copy(ies) may be attached.)

7. What would you like the Library to do about this item?

8. Is there an item you would suggest in place of or in addition to the item in question?

Other Comments:


Your signature (required)

Thank you for filling out this form.