IJJ-E (FORM)- CITIZEN’S CHALLENGE OF EDUCATIONAL MEDIA FORM
CITIZEN’S CHALLENGE OF EDUCATIONAL MEDIA FORM
Type of Material:
__ Book
__ Magazine/Periodical
__ Film/DVD
__ Audio Recording
__ Software | Developer (if known): _____________________________________
__ Other (Please specify):_______________________________________
Title: _________________________________________________________________________
Publisher (if known): ____________________________________________________________
Person making complaint: ________________________________________________________
Address: ____________________________________________ Telephone: __________________________
Email: ___________________________________________
Complaint represents:
__ Self
__ Organization/Group (Please name): _______________________________________
1. Identify any particular sections to which you object. (Please be specific: cite pages, scenes, etc.)
2. What do you feel might be the negative result of reading/viewing/hearing this material?
3. For what age group would you recommend this material?
4. Did you read/view/hear all of the material? YES or NO If not, what parts did you read/view/hear?
5. What are the positive aspects of this material?
6. Please identify any professional review/judgments of this material that you have read.
7. What do you believe is the theme and/or intention of this material?
8. 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.
__ Refer it to the Educational Media Review Committee for evaluation.
Signature of Complainant
Date
Cross Reference:
Adopted:
- September 10, 2013
Reviewed/Revised:
- June 11, 2024