IJJ-E (FORM)- CITIZEN’S CHALLENGE OF EDUCATIONAL MEDIA FORM
CITIZEN’S CHALLENGE OF EDUCATIONAL MEDIA FORM
Type of Material:
🙿 Book 🙿 Magazine/Periodical 🙿 Film 🙿 Recording
🙿 Software 🙿 Other (please Specify:_______________________________________
Title: _________________________________________________________________________
Publisher (if known): ____________________________________________________________
Person making complaint: ________________________________________________________
Address: _________________________________ Telephone: __________________________
Complaint represents:
🙿 Self
🙿 Organization/Group (please name):
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Why do you object to this material?
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Identify any particular sections to which you object. (Please be specific: cite pages, scenes, etc.)
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What are the positive aspects of this material?
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Did you read/view/hear all of the material? If not, what parts did you read/view/hear?
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Please identify any professional review/judgments of this material that you have read.
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What would you like the school to do about this material?
🙿 Do not assign to any students. 🙿 Withdraw it from the library and/or instructional program.
Signature of Complainant | Date
Cross Reference:
Adopted:
- September 10, 2013