Citizen Reconsideration Form
Citizen Form for Reconsideration of Materials

Title _______________________________________________ Book  Periodical Other

Author _____________________________________________

Publisher ___________________________________________

Request by __________________________________________

Address ____________________________________________

City ________________State __________ Zip _____________

Telephone _____________Email ________________________

1   
To what in the work 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 work?

4   
Is there anything good about this work?

5   
Did you read the entire book?

6   
Are you aware of judgments of this work by literary critics?

7   
What do you feel is the theme of this work?

8   
What would you like your library to do about this?

 Do not assign/lend to my child.

 Return it to the staff selection committee/department for reevaluation.

 Other _______________________________________