Request for reconsideration of printed or multi-media instructional materials should be submitted to the superintendent.
Review Initiated By:
School(s) in which item is used:
Relationship to school (parent, student, citizen, etc.):
Book or Other Printed Material (If applicable):
Hardcover______ Paperback_____ Other_____
Publisher (if known):
Date of publication:
Multi-Media Materials (If applicable):
Producer (If known):
Type of material (filmstrip, motion picture, etc.):
Person making the request represents (circle one): Self Group/Organization
Name of Group/Organization:
Address of Group/Organization:
1. What brought this item to your attention?
2. To what in the item do you object? (Be specific; cite pages, frames, etc.)
3. In your opinion, what harmful effects upon students might result from use of this item?
4. Do you perceive any instructional value in the use of this item?
5. Did you review the entire item? If not, what sections did you review?
6. Should the opinion of additional experts be considered? _____Yes _____ No
If yes, please list specific suggestions:
7. To replace this item, do you recommend other material which you consider to be of equal or superior quality for the purpose intended?
8. Do you wish to make an oral presentation to the reconsideration committee?
a) Please contact the superintendent
b) Please be prepared at this time to indicate the approximate length of time your presentation will require.
Although this is no guarantee that you'll be allowed to present to the committee or that you will get your requested amount of time. _______ Minutes
Signature _____________________________________________________ Date: ____________________
Reviewed: 9/13; 4/15; 1/18; 2/21
Related Policy: 602.28; 602.29; 602.29-R
IASB Reference: 605.E2