Stevensville School District

INSTRUCTION                                                                                        2310F

Request for Reconsideration of Library Material

Stevensville School District #2

Stevensville, Montana

 

 

Name: ______________________________________                               Date: ____________________

 

Address: _____________________________________     City: ___________________     State: ______

 

Phone: ______________________

 

Title: _________________________________________   Author: _______________________________

 

Type of resource on which you are commenting (check):

 

__Book     __Textbook    __Magazine    __Newspaper    __ Library Program    __Display

 

__Audio Recording   __Video    __Electronic Information/Network: _____________________________

 

__Other: _____________________________________________________________________________

 

Location:  High School          Middle School       Elementary School

 

Please respond to the following questions. If more space is needed use an additional sheet.

  1. Have you read, seen, or listened to this resource in its entirety?

 

 

 

 

 

 

  1. What concerns you about the resource? (Please be specific; cite examples)

 

 

 

 

 

 

 

  1. For what other age groups might this resource be suitable?

 

 

 

 

  1. What action do you recommend the school take on this resource?

 

 

 

 

 

 

 

 

_____________________________________                                                    Date: _____________

(Signature of Complainant)

 

PLEASE RETURN THIS FORM TO THE BUILDING PRINCIPAL. 

 

 

Received by principal: _____________________________                                    Date: _____________

 

Principal:

____ Provided a copy to the library media specialist.                                          Date: _____________

 

____ Met with two district library media specialists to review inquiry.                    Date: _____________

 

____ Met with complainant to discuss the complaint and render a decision.         Date: _____________

 

____ Complaint was resolved and no further action needed.                                Date: _____________

 

____ Complaint was not resolved and complainant will be forwarded to a               Date: _____________

review committee.

 

Reviewed on: December 11, 2018

Adopted on: January 8, 2019

Revised on: