Policy Code: 3210A
REQUEST FOR RECONSIDERATION OF INSTRUCTIONAL MATERIALS
Name of Person making request __________
Telephone ___ Address ________
Complainant represents: _ Himself Organization (name) ____ __ Other Group (name) ____
Name of School owning challenged material ______
Title of item challenged ___________
Type of media (book, film, recording, etc.) _______
Author/artist/composer/producer __________
Publisher/producer (if known) ____________
- What do you believe are the theme and purpose of this item? ___
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For what age group would you recommend this item? ________
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What do you feel might be the result of a student’s reading, viewing, or listening to this
item? ____________
- To what in this item do you object? (Specify/cite: pages, photos, frames, etc.)
- Is there anything good about this item? Explain ______
- Did you read, view, or listen to the entire item? ___ If not, what parts? ______
Avery County Schools Policy Page 1 of 2 Policy Code: 3210A
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Are you aware of the evaluation of this item by authoritative sources? _______
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What would you like your school to do about this item? __ Do not assign it to any child _ Withdraw it from all students as well as your child. Refer it to the media coordinator’s office for reevaluation. ___ Make it available only to those who wish to use it.
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In its place, what item of equal educational quality would you recommend to convey as valuable a concept and perspective of the subject covered by this item?
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Avery County Schools Policy Page 2 of 2