Citizen's Request for Reconsideration of Non-Print Material
Date_____________
Format: Audio/Cassette _____ Video/Cassette
____ Compact Disc ____ DVD____ Other _____
Video or Recording Title: _______________________
Your name: _______________________________________
Telephone: _______________ Address: _____________________
City: ____________________ Zip Code: ______________
You represent:
______self
______Name of group or organization _________________________
1. To what in this item do you object: (Please
be specific) _________________________________________________________
2. What do you feel might be the result of viewing/listening
to this material? _______________________________________________________
3. For what age group would you recommend this item?
_________
4. Did you view/listen to the entire material? _______
What parts? _______________________________________
5. Is there anything good about it?_________________________________
6. Are you aware of the judgement of this material
by critics?_______________
7. What do you believe is the theme of this material?
___________________
8. What brought this item to your attention?
_______________________
9. What would you like the Library to do about this
material? _________________________________________________________
10. In its place, what item of similar content would
you recommend?_______________________________________________
11. Have you read the Lorain Public Library System
Policies as stated on the other side of this form? ________________________________
______________________
Your Signature
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Staff person take request _______________
Comments: __________________________________________________
___________________________________________________
Database # ______________________