Sample Reconsideration Form
Selection & Reconsideration Policy Toolkit for Public, School, & Academic Libraries
Sample Request for Reconsideration of Material Form. See the examples for public, school, and academic libraries below.
Sample Public Library Request for Reconsideration of Material Form
[PDF]
The trustees of Mainstream Public Library have established a materials selection policy and a procedure for gathering input about particular items. Completion of this form is the first step in that procedure. If you wish to request reconsideration of a resource, please return the completed form to the library director.
Mainstream Library
1 Mainstream Plaza
Anytown, State Zip
Date ___________________________________________________________
Name __________________________________________________________
Address ________________________________________________________
City ____________________________ State/Zip _______________________
Phone __________________________ Email __________________________
Do you represent self? ____ Or an organization? ____ Name of Organization ___________________________
1. Resource on which you are commenting:
___ Book (e-book) ___ Movie ___ Magazine ___ Audio Recording
___ Digital Resource ___ Game ___ Newspaper ___ Other
Title ________________________________________________________________________
Author/Producer _______________________________________________________________
2. What brought this resource to your attention?
___________________________________________________________
3. Have you examined the entire resource? If not, what sections did you review?
___________________________________________________________
4. What concerns you about the resource?
___________________________________________________________
5. Are there resource(s) you suggest to provide additional information and/or other viewpoints on this topic?
___________________________________________________________
6. What action are you requesting the committee consider?
___________________________________________________________
Sample School Library Request for Reconsideration of Material Form
[PDF]
The school board of Mainstream County, U.S.A., has delegated the responsibility for selection and evaluation of library/educational resources to the school library professional staff/curriculum committee, and has established reconsideration procedures to address concerns about those resources. Completion of this form is the first step in those procedures. If you wish to request reconsideration of school or library resources, please return the completed form to the coordinator of library media resources (or principal).
Mainstream School District
1 Mainstream Plaza
Anytown, State Zip
Date ___________________________________________________________
Name __________________________________________________________
Address ________________________________________________________
City ____________________________ State/Zip _______________________
Phone __________________________ Email __________________________
Do you represent self? ____ Or an organization? ____ Name of Organization ___________________________
1. Resource on which you are commenting:
___ Book (e-book) ___ Movie ___ Magazine ___ Database
___ Audio Recording ___ Digital Resource ___ Textbook ___ App
___ Newspaper ___ Game ___ Streaming Media ___ Other
Title ________________________________________________________________________
Author/Producer _______________________________________________________________
Is the resource part of the curriculum, library collection, or other?
___________________________________________________________
2. What brought this resource to your attention?
___________________________________________________________
3. Have you examined the entire resource? If not, what sections did you review?
___________________________________________________________
4. What concerns you about the resource?
___________________________________________________________
5. Are there resource(s) you suggest to provide additional information and/or other viewpoints on this topic?
___________________________________________________________
6. What action are you requesting the committee consider?
___________________________________________________________
Sample Academic Library Request for Reconsideration of Material Form
[PDF]
The faculty at Mainstream Academic Library, U.S.A., have established a materials selection policy and a procedure for gathering input about particular items. Completion of this form is the first step in that procedure. If you wish to request reconsideration of a resource, please return the completed form to the dean of libraries.
Mainstream Academic Library
1 Mainstream Plaza
Anytown, State Zip
Date ___________________________________________________________
Name __________________________________________________________
Address ________________________________________________________
City ____________________________ State/Zip _______________________
Phone __________________________ Email __________________________
Do you represent self? ____ Or an organization? ____ Name of Organization ___________________________
1. Resource on which you are commenting:
___ Book (e-book) ___ Movie ___ Magazine ___ Audio Recording
___ Digital Resource ___ Textbook ___ Newspaper ___ Other
Title ________________________________________________________________________
Author/Producer _______________________________________________________________
2. What brought this resource to your attention?
___________________________________________________________
3. Have you examined the entire resource? If not, what sections did you review?
___________________________________________________________
4. What concerns you about the resource?
___________________________________________________________
5. Are there resource(s) you suggest to provide additional information and/or other viewpoints on this topic?
___________________________________________________________
6. What action are you requesting the committee consider?
___________________________________________________________
Home | Introduction
Why Do I Need a Policy? | Politics and Timing of Policy Creation | Selection Policies for Non-Public Institutions
Basic Components of a Selection Policy
Library Mission | Support for Intellectual Freedom | Objectives | Responsibility for Selection | Selection Criteria | Acquisitions Procedures | Special Collections | Selecting Controversial Materials | Gifts and Donations | Collection Maintenance and Weeding | Policy Revision | Reconsideration
Reconsideration Procedure
Guiding Principles | Statement of Policy | Informal Complaints | Request for Formal Reconsideration | Sample Reconsideration Form | Sample Letter to Complainant | Reconsideration Committees
Appendix
Intellectual Freedom Core Documents | Challenge Support and Reporting Censorship | Bibliography of Additional Selection and Reconsideration Policy Resources