Request for Reconsideration of Library Materials

Date(Required)

Title of Item(Required)

Author(Required)

Publisher

Date of Publication(Required)

Type of Material (book, movie, video game, etc)(Required)

Client Name(Required)

First Last

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email Address(Required)

Are you representing a group or organization? If yes, please provide the name of the group.

What brought this material to your attention? (reviews, word-of-mouth, etc)(Required)

If reviews, please give name and date of publication, if possible.

Have you read, seen, or listened to the entire item?(Required)

Yes

What are your concerns about this material? (Please be as specific as possible: cite pages or sections)(Required)

What action are you requesting the Library consider for this item, and why?(Required)