Request for Reconsideration of Library Materials Form

2. First Name*
3. Last Name*
5. Phone*
7. Representing*

   1. Self

   1. Organization
8. Name of Organization
10. Title of Item in Question*
12. Author*
14. Publisher
15. Publication Date
17. Did you read, view, or listen to the entire work?

    1. yes

    1. no
19. If you examined only portions of the item, please chapter(s), section(s), page(s), etc.
21. What in the work do you object to? Please be specific (cite pages or sections).
23. What do you feel might be the result of reading, viewing, or listening to this work?
25. What do you believe is the theme or purpose of this work?
27. What value is there in this work?
29. What work do you recommend or represent your viewpoint?
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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