AVERY-MITCHELL-YANCEY REGIONAL LIBRARY
REQUEST FOR RECONSIDERATION OF LIBRARY MATERIALS

BOOK___________________________________________________________
MAGAZINE_______________________________________________________
OTHER (specify)_________________________________________________________
Author___________________________________________________________
Title_____________________________________________________________
Publisher ( if known) ______________________________________________________
Request initiated by________________________________________________________
Telephone________________Address_________________________________
City___________________________________State & Zip Code___________________

Complainant represents:
________himself/herself_____________________________________________
________organization (name)________________________________________________
________other group(name)_________________________________________________

NOTE: In order for a complaint to be reviewed, ALL questions must be answered (use separate sheet).

1. To what in the book or material do you object? (Please be specific; cite pages)
2. What do you feel might be the result of reading this book/material?
3. For what age group would you recommend this book/material?
4. Is there anything good about this book/material?
5. Did you read or view the entire book/material?
6. Are you aware of the judgment of this book/material by literary critics?
7. What do you believe is the theme of this book/material?
8. What would you like the library to do about this book/material?
   ________restrict its use to select group of adults
   ________withdraw it from all circulation
   ________have it reevaluated by library officials
9. In its place, what book or material of equal literary quality would you recommend that would convey
   as valuable a picture and perspective of the issue/ theme?
10. Would you like a written response to this request? _____Yes_____No
    If yes, please allow 15 business days from the date you mail this request.

Please see Main Librarian for proper mailing address.

_________________________________
Signature of Main Librarian @ Library where complaint originated
_________________________________
Name of Public Library
_____________________________
Date
__________________________________
Signature of Complainant
______________________________
Date
[ Adopted 8/2002 ]