IJJ-E (FORM)- CITIZEN’S CHALLENGE OF EDUCATIONAL MEDIA FORM
CITIZEN’S CHALLENGE OF EDUCATIONAL MEDIA FORM
Type of Material:
?__ Book
__ Magazine/Periodical
__ FilmFilm/DVD
__ Audio Recording
?__ Software ?| Developer (if known): _____________________________________
__ Other (please Specify:Specify):_______________________________________
Title: _________________________________________________________________________
Publisher (if known)known): ____________________________________________________________
Person making complaint: ________________________________________________________
Address: _____________________________________________________________________________ Telephone: __________________________
Email: ___________________________________________
Complaint represents:
?__ Self
?__ Organization/Group (please name)name): _______________________________________
Why do you object to this material?Identify any particular sections to which you object. (Please be specific: cite pages, scenes, etc.)
What
aredo you feel might be thepositivenegativeaspectsresult of reading/viewing/hearing this material?- 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?
- What are the positive aspects of this material?
6. Please identify any professional review/judgments of this material that you have read.
- 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?
1.
2.
3.
5.
7.
?__ 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