Adopted: February 1987
Revised: September 2025
Download 603.4P - Request for Reconsideration of Instructional Resources or Library Materials
TO BE COMPLETED BY THE PERSON REQUESTING RECONSIDERATION: Please fill in the information requested and respond to the following questions. If more space is needed, use additional sheets of paper.
Request initiated by:
Phone:
Address:
Requestor represents: self: others (specify)
organization or group (specify)
Title of questioned resource
Author or creator
Publisher or producer
Copyright
Type of resource (book, periodical, etc.)
- In which school, library or class, grade level and subject area can this resource be found?
- How did you become aware of this resource?
- Did you read, view, listen to or observe all the resource in question? If not, what parts did you read, view, listen to or observe?
- Do you need help obtaining a copy of the resource for you to review?
- To what do you object about this resource? Please be specific.
- Please comment on the resource as a whole.
- Please set forth the resolution you seek.
- Who have you discussed your concern within the district (teacher, principal, media specialist etc.)?
- Do you wish to make comments at the Reconsideration Review Committee meeting?
X
Signature Date
PLEASE RETURN THIS FORM TO YOUR PRINCIPAL.
RECEIVED BY PRINCIPAL
X
Signature of Principal Date School
TO BE COMPLETED BY PRINCIPAL: Please respond to the following questions and return this completed form to the director of elementary education or director of secondary education (as appropriate). Include the district technology specialist if the request relates to library materials.
If this request relates to instructional resources, did you offer an alternative instructional option to this person?
If yes, what was their response?
If no, why not?
RECEIVED BY DIRECTOR OF ELEMENTARY EDUCATION OR DIRECTOR OF SECONDARY EDUCATION
X
Signature Date