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REQUEST FOR REEVALUATION OF

INSTRUCTIONAL MATERIALS

1420-E

Request initiated by: ____________________________________________________________

Date: _______________________________  Telephone:   ______________________________

 

Address: ______________________________________________________________________

Complainant represents: Self__________

Group (name): _________________________________________________________________

TITLE: _______________________________________________________________________

AUTHOR:_____________________________________________________________________

Publisher or Producer: ___________________________________________________________

Publisher's recommended grade level: ___________

 

Book ________ AV Material (please specify format) __________      Other __________

Have you read/heard/seen the material in its entirety? ____________

1.      To To what do you specifically object? Please cite specific passages, pages, etc.

            ________________________________________________________________________

2.      Is y Is your objection to this material based upon your personal exposure to it, upon reports  you have heard, or both?

            ________________________________________________________________________

3.      WhWhat do you believe is the theme or purpose of the material?

            ________________________________________________________________________

4.      WhWhat do you feel might be the result of reading/viewing this work?

            ________________________________________________________________________

5.      In iIn it's place, what work of equal value would you recommend that would convey as valuable a picture and perspective of a society or a set of values?

            ________________________________________________________________________

Do you wish to make an oral presentation of 15 minutes or less to the Materials Review Committee?_______

__________________________________                _________________

Signature                                                                      Date

 
Date of Approval:         December 9, 2002