Stevensville School District
Request for Reconsideration of Library Material
Stevensville School District #2
Name: ______________________________________ Date: ____________________
Address: _____________________________________ City: ___________________ State: ______
Title: _________________________________________ Author: _______________________________
Type of resource on which you are commenting (check):
__Book __Textbook __Magazine __Newspaper __ Library Program __Display
__Audio Recording __Video __Electronic Information/Network: _____________________________
Location: High School Middle School Elementary School
Please respond to the following questions. If more space is needed use an additional sheet.
- Have you read, seen, or listened to this resource in its entirety?
- What concerns you about the resource? (Please be specific; cite examples)
- For what other age groups might this resource be suitable?
- 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: _____________
____ 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: _____________
Reviewed on: December 11, 2018
Adopted on: January 8, 2019