Lockwood School District #26 2314F CITIZEN’S REQUEST FOR RECONSIDERATION OF MATERIALS Author_________________________Hardcover_____Paperback_____Other___ Title_____________________________________________________________ Publisher (if known)_______________________________________________ Request initiated by_______________________________________________ Address__________________________________________________________ City____________________State________Zip_______Phone______________ Complainant represents: __________Self __________Name of Organization __________Identify Other Group (If objection is to material other than a book, change wording of the following questions so that they apply). 1. To what in the book do you object? (Please be specific: cite pages). 2. What do you feel might be the result of reading this book? 3. For what age group would you recommend this book? 4. Is there anything good about this book? 5. Did you read the entire book? 6. Are you aware of the judgment of this book by literary critics? 7. What do you believe is the theme of this book? 8. What would you like your library/school to do about this book? _____Do not assign/lend it to my child _____Withdraw it from all readers/students as well as my child _____Send it back to the staff selection official/English Department for re-evaluation 9. In its place, what book of equal literary quality would you recommend that would convey as valuable a picture and perspective of the subject treated? Date____________ Signature of Complainant _________________________________