Appendix C

Request for Reconsideration of Materials

Title: __________________________________________________________________

Author: ________________________________________________________________

Format (book, video, other): ________________ Publisher (if known): ____________

Request initiated by: _____________________________________________________

Telephone: __________________ Address: ___________________________________

City: ____________________________________ Zip code: ______________________

Client represents:

_________ Himself/Herself

_________ Organization/Name _________________________________________

1. Did you read the cover letter outlining Whitman County Library’s role as a public library and its commitment to the principles of intellectual freedom?

2. Have you read the entire book (if not a book, viewed or listened to the item in its entirety)? If not, what parts?

3. Why do you disapprove of this material? (Be as specific as possible.)

4. How do you suggest the library deal with this material?

5. Can you suggest an alternative to take its place?

Signature of citizen _____________________________ Date ____________________

Name of receiving staff member ____________________________________________

Please forward this completed form and the material in question to:

Director

Whitman County Library

S. 102 Main

Colfax, WA 99111