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Title <br />Request for Reconsideration of Print Materials <br />Book Periodical Other <br />Author <br />Publisher <br />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 read the entire work? If not, what parts? <br />3. What do you feel might be the result of reading this work? <br />4. For what age group would you recommend this work? <br />5. What do you believe is the theme of this work? <br />6. Are you aware of judgments of this work by literary critics? <br />7. What would you like your library to do about this work? <br />8. In its place, what work 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 />61 <br />