• RECONSIDERATION OF INSTRUCTIONAL MATERIALS

     

    RECONSIDERATION REQUEST FORM

     

    Request for re-evaluation of instructional materials to be submitted to the superintendent.

     


    REVIEW INITIATED BY:

    DATE:


     

     

    Name:

     

    Address:

     


    City/State :             Zip Code:

     

    School(s). in which item is used:

     

    Relationship to school (parent, student, citizen, etc.)


    Telephone


     

     

    BOOK OR OTHER PRINTED MATERIAL IF APPLICABLE:

     

    Author:

    Hardcover ‑ Paperback or Other:
    Title:
    Publisher (if known):
    Date of Publication

     

    AUDIOVISUAL MATERIAL IF APPLICABLE:

     

    Title:

     

    Producer (if known):

     

    Type of material (filmstrip, motion picture, etc.):

     

    PERSON MAKING THE REQUEST REPRESENTS: (circle one)

     

                    Self         Group or Organization

     

                    Name of group:

     

                    Address of Group:

     

    1. What brought this item to your attention?

     

    2. To what in the item do you object? (please be specific; cite pages, or 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?

     


     

    Should the opinion of any additional experts in the field 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 Review Committee?

     

    If yes:

    (a) Please call the office of the Superintendent

     

     (b) Please be prepared at this time to indicate the approximate length of time your presentation will require: ______minutes


     

     

    Dated: ____________                                       Signature: ________________________________