ALGONQUIN AREA PUBLIC LIBRARY

FORM FOR RECONSIDERATION OF LIBRARY MATERIAL

Format (Book,DVD,etc)___________________________________________________

Author (if applicable)______________________________________________________

Title____________________________________________________________________

Publisher _______________________________________________________________

Your name __________________________________ Phone #_____________________

Address ________________________________________________________________

Do you represent:

Yourself _______ An organization (name) _____________________________________

Did you read/view/listen to the entire work?____________________________________

If not, what sections have you examined?_______________________________________

Why do you object to this item? (Please be specific, citing pages, sections, etc.)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

What prompted you to read, view, or listen to this item?_____________________________

__________________________________________________________________________

For what age group would you recommend this item?________________________________

What action would you like the library to take in regard to this work?

 __________________________________________________________________________

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Signature___________________________________________________________________