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

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

2. 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