605.3E2 - Reconsideration of Instructional Materials & Library Material Request Form

CODE NO. 605.3-E2

 

RECONSIDERATIOIN OF INSTRUCTIONAL AND LIBRARY MATERIAL REQUEST FORM

Request for re-evaluation of printed or multimedia material to be submitted to the superintendent.

REVIEW INITIATED BY:

 

DATE:

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

City/State

 

Zip Code

 

Telephone

 

 

 

 

 

 

 

School(s) in which item is used

 

 

 

 

 

 

 

 

 

Relationship to school (parent, student, citizen, etc.)

 

 

 

 

 

 

 

 

BOOK OR OTHER PRINTED MATERIAL IF APPLICABLE:

 

 

 

 

 

 

Author

 

Hardcover

 

Paperback

 

Other

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

Publisher (if known)

 

 

 

 

 

 

 

 

 

 

 

Date of Publication

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MULTIMEDIA MATERIAL IF APPLICABLE:

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

Producer (if known)

 

 

 

 

 

 

 

 

 

 

 

Type of material (website, online resource, filmstrip, motion picture, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERSON MAKING THE REQUEST REPRESENTS: (circle one)

 

 

 

 

 

 

 

Self

 

Group or Organization

 

 

 

 

 

 

 

 

Name of group

 

 

 

 

 

 

 

 

 

 

 

Address of Group

 

 

 

 

 

 

 

 

 

 

 

 
                                                     

8.

Do you wish to make an oral presentation to the Review Committee?

 

 

 

 

 

 

 

 

 

Yes

(a) Please contact the Superintendent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
  1. Please be prepared at this time to indicate the approximate length of time your presentation will require.  Although this is no guarantee that you'll be allowed to present to the committee, or that you will get your requested amount of time.

 

 

 

 

 

 

 

Minutes.

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dated

 

Signature

 
               

Legal Reference:           Iowa Code § 279.8, § 280.14, § 280.3,§ 301; 279.74; 281 I.A.C. 12.3 

Cross Reference:           213       Public Participation in Board Meetings

 

Adopted:          03/03/1986                   Reviewed:        02/10/2025            Revised:           11/21/2022

File Attachments
605.3E2-Reconsideration of Instructional & Library Materials Request Form.docx.pdf