Boulder Valley School District

KEC-E1

  • K
  • School-Community Relations

File:   KEC-E1 (pdf)
Revised:  January 15, 2014



PATRON REQUEST FOR RECONSIDERATION OF LEARNING MATERIALS

Boulder Valley School District recognizes the right of individuals and groups to present complaints or concerns directly related to learning materials.  This form provides a format for requesting reconsideration of learning materials.  

PLEASE FEEL FREE TO ATTACH PAGES AS NEEDED.  

Type of Materials: _____ Book _____ Other Media: _________________________________
                                (specify type)

Author: _________________________________ Title: ______________________________

Publisher (if known): _______________________ Copyright/Edition:___________________

Request initiated by: _________________________________________________________

Address: ___________________________________________________________________

City: _________________________ State: __________ Zip Code:______________________

Telephone: ____________________________________

School where material is located: _______________________________________________

Patron Represents

___ Self
___ Organization or Group: ____________________________________________________
                                                             (organization/group name)

1.    Did you read/view listen to/interact with the entire item? ___________  If not, what parts have you read, viewed,

listened to, or interacted with? ___________________________________________________

___________________________________________________________________________


2.    To what do you object? (please be specific: cite pages, passages, references) _________
___________________________________________________________________________
___________________________________________________________________________

3.    What do you believe is the central theme of the material? _____________________
___________________________________________________________________________
___________________________________________________________________________

4.    In this material, what needs to be balanced by other information? (Please be specific: cite pages, passages, references)__________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

5.    What material would counterbalance the point of view of this material? _______________
___________________________________________________________________________
___________________________________________________________________________

6.    For what age group would you recommend this material? __________________________
___________________________________________________________________________
___________________________________________________________________________

7.    In its place, what materials, if any, would you recommend? _________________________
___________________________________________________________________________
___________________________________________________________________________

 

_________________________________________        __________________________
    Signature of Patron                                                          Date


Adapted from: Colorado Library Association, MLA, Mississippi, 1982

End of File: KEC E1