Glenbard Township High School District 87
Policy 6:260-E1
Instruction
Exhibit – Request for Reconsideration of Instructional Materials
To be submitted to the Building Principal.
School:_____________________________________
Please check type of material:
___Book ___Film ___Record
___Periodical ___Filmstrip ___Kit
___Pamphlet ___Cassette ___Other
Title: ____________________________________________________________________________________
Author:___________________________________________________________________________________
Publisher or Producer:_______________________________________________________________________
Request Initiated By:________________________________________________________________________
Representing:______________________________________________________________________________
Telephone:_________________________ Address:_______________________________________________
City:________________________________ State:___________ Zip Code:_____________________________
The following questions are to be answered after the complainant has read, viewed, or listened to the
school library material in its entirety. If sufficient space is not provided, attach additional sheets.
(Please sign your name to each additional attachment.)
1. To what in the material do you object? (Please be specific, cite pages, frames in filmstrip, film sequence, etc..)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
2. What do you believe is the theme or purpose of this material?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
3. What do you feel might be the result of a student using this material?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
____________________________________________________ _________________________________
Signature of Complainant Date
DATED: March 1999
REVIEWED: January 17, 2006
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