Skip to: Content
Skip to: Section Navigation
Skip to: Site Navigation
Skip to: Search

 

Online Challenge Reporting Form

BOOK INFORMATION

Title:

Author:

Copyright/Issue Date:

Publisher:

TYPE OF WORK (Mark with Capital "X")

Book      Textbook    Magazine  Newspaper    Pamphlet   Student Publication Artwork   Film   Photo Sound Recording   Video   CD-ROM Collection   Exhibit    Performance Speech   On-line Resource Other:

GROUNDS FOR CHALLENGE (Mark all that apply with capital "X")

Cultural Grounds:

Anti-Ethnic    Insensitivity    Racism Sexism   Inaccurate

Sexual Grounds:

Homosexuality   Nudity   Sex Education Sexually Explicity   Unsuited to Age Group

Value Grounds:

Anti-Family    Offensive Language   Political Viewpoint   Religious Viewpoint   Violence

Social Issues:

Abortion   Drugs   Occult/Satanism   Suicide

Other Reason for Challenge

 

INITIATOR OF CHALLENGE (Mark with capital "X")

Administrator   Board Member   Clergy   Parent   Teacher   Patron   Elected Official   Government   Pressure Group   Religious Organization   Other Initiator (please describe)

Organizations Supporting the Challenge

 

INSTITUTION BEING CHALLENGED

Name

Address

Address (cont.)

City State (abbrev.) Zip Code

Phone

Fax

E-mail

TYPE OF INSTITUTION BEING CHALLENGED

School (Classroom):   School Library:   Grade Level Affected  to  Academic Library   Public Library   Prison Library   Special Library   College/University Community Group  Museum/Gallery   Publisher   Student Group   Theater  

Other:

 

CONTACT INFORMATION:

Name 

Address

Address (cont.)

City State (abbrev.) Zip Code

Phone

Fax

E-mail

STATUS OF MATERIAL

Unknown   Material Retained   Material Removed   Material Stolen/Defaced

If you have trouble reading this form with your browser, or if you prefer to fax (312-280-4227) or mail in your challenge report, print out the Word form or PDF form, and send to Bryan Campbell (Office for Intellectual Freedom, American Library Association, 50 East Huron Street, Chicago, IL 60611 or FAX: 312-280-4227). You may also call Bryan at 1-800-545-2433, ext. 4220, or e-mail him at Bryan Campbell