Appendix C: Sample Reconsideration Form

Statement of Concern about Library/Media Centre Materials: (Name of your organization here)

Name of library branch or school:

Your name:




Postal code:

Phone number:

E-mail address:

Name of any organization you represent:

Resource on which you are commenting:
___ Book
___ Audiovisual resource
___ Magazine
___ Content of library program
___ Newspaper
___ Other (specify):

Copyright date:

Please include an attachment if required for the following questions:

What brought this resource to your attention? (For reviews, please give publication details if possible.)

Have you read/viewed the entire work? If not, what sections did you review?

To what do you object? Please be specific and give page references where applicable.

What in your opinion is the author’s/producer’s theme?

What resources do you suggest to provide additional information on this topic?

What action are you recommending?


(Add an outline of what happens next according to your policy.)