Citizen's Request for Reconsideration of Instructional Materials

E 1312.20

 

Date: ____________________

TITLE: __________________________________________________________________________________

AUTHOR: ______________________________________________________________________________

PUBLISHER: ____________________________ DATE OF EDITION: ___________________________

Request received by: _______________________________ Title: ________________________________

Citizen’s Name: ____________________________________ Phone: _____________________________

Citizen Represents:    Himself/Herself: ____________ Organization or Group: _____________________________ 

 

To what do you object? (Please be specific: cite pages, tape sequence, video frame, and words)


What do you feel would be the result of reading/viewing this material?

For what age group would you recommend this material?

Did you read/view the entire selection?
If not, what percentage did you read/view, or what parts? Is there anything good about this material?

What would you like the school to do about this material?

 _________Do not assign it to my child. _________Withdraw it from all students. _________Reevaluate it.

Are you aware of how this work has been assessed by literary critics?

What do you believe is the thesis of this work?


In its place, what work would you recommend?

 

 ________________________________________________________
                             Signature of citizen 





Action taken:______________________________________    Date:__________________________________

 

KETCHIKAN GATEWAY BOROUGH SCHOOL DISTRICT
Adoption Date: 10/13/99
Revision Date: 8/14/2019

 

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