Request for Reconsideration of Library Materials

Monroe County Public Library * 303 E. Kirkwood * Bloomington, IN 47408 * 812-349-3050

Please print except for signature. Attach additional pages as necessary.

Patron Name (please print): _________________________________________ Date:____________

Address: _____________________________________________ Zip: ________________________

Phone Number:_______________________ Email:________________________________________

Do you represent an organization? Yes_____ No_____

If yes, what organization? ________________________

Media Type (please circle one):

___Audiobook ___Book ___DVD ___Magazine ___Audio CD ___Other_______________

Author:___________________________________________________________________

Title:_____________________________________________________________________

Call Number:______________________________ Copyright Date:____________________



1. How did this material come to your attention?




2. Did you read/listen/view this material completely? __ Yes __ No




3. In your view, what is the topic or theme of this material?




4. What is your objection to the material? Be as specific as you can; list page numbers as appropriate.




5. Did you find something good or worthwhile about this material? ___ Yes ___ No
If yes, what?



6. What age group do you think the material is appropriate for?


7. What action would you like taken regarding this material?




8. Are there other materials you recommend to provide additional information or points of view on this topic? (Attach another page as needed.)




Thank you. Your request will be reviewed by the Library Director for action.


FOR STAFF USE ONLY

Status Report on Patron Request for Reconsideration of Library Material

Date Action
  Name of staff member initially contacted by patron: ________________________
  Reconsideration form returned to library and copy sent to appropriate department manager. Original form sent to Library Director.
  Library patron contacted by Library Director and informed of reconsideration process.
  Chair of Collection Development Committee forms Reconsideration Committee in consultation with Library Director.
  Reconsideration Committee meets, researches the material, and discusses request.
  Decision of Reconsideration Committee sent to Library Director.
  Library Director informs patron by letter of the library's decision.
  Copies of Director's letter are sent to members of the Reconsideration Committee and to the Library Board of Trustees.
 Signature of Library Director: ____________________________ Date:_________

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