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