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Title <br />Request for Reconsideration of Audiovisual Materials <br />Format <br />Author <br />Producing Company (if known) <br />Year produced/Copyright date <br />Request initiated by <br />Address <br />City State Zip <br />Telephone (Home) (Work) <br />Library Card # <br />Do you represent: Yourself An organization Other group (name) <br />1. To what in the work do you object? Please be specific. <br />2. Did you view/listen to the entire material <br />If not, what parts? <br />3. What do you feel might be the result of exposure to this material? <br />4. For what age group would you recommend this material? <br />5. What do you believe is the theme of this material? <br />6. Are you aware of judgments of this material by professional critics? <br />7. What would you like your library to do about this material? <br />8. In its place, what material would you recommend? <br />Signature Date <br />PLEASE NOTE: This is a public document under Public Law. Your name and address are subject to <br />disclosure upon public request. <br />60 <br />