Request for Reconsideration Form

Title(Required)

Author(Required)

Publisher(Required)

Request initiated by (Full name)(Required)

Email Address(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Library card #(Required)

How was the book/item brought to your attention? Explain in detail.(Required)

Do you know, or have you read anything about the author? Explain in detail.(Required)

Did you read/watch the entire book/item?(Required)

Yes

Are you considering the book as a whole? (Explain in detail)(Required)

What in your opinion is the theme of the book? Explain in detail.(Required)

What do you object to in the book/item? (Explain in detail)(Required)

Have you read or heard any reviews of the book? If yes, please provide specific links, articles, etc.(Required)

In your opinion is there anything constructive about the book/item? (Explain in detail)(Required)

How would you like the Library to respond to your complaint about the book/item?(Required)

Do not loan to some patrons

Re-evaluate the book

Withdraw it from the Library

Explain your choice in detail below.(Required)

To submit the request, this form must be printed, signed, and dated.