Complaint+Form

Complaint/Re-evaluation Form
Original at [].

Book: WCSD Policy Manual Section: 1000 Community Relations Title: Request for Re-evaluation of Instructional Materials Number: 1420-E Status: Active Adopted: September 20, 1994

Request Initiated by:

Date: Telephone:

Address:

Complainant represents: self group

__TITLE:___

__AUTHOR:__

Publisher or Producer: _

__Publisher's recommended grade level:__ _

__Book__ _ AV Material (please specify format) __Other__

__1. Have you read/heard/seen the material in its entirety?__

2. To what do you specifically object? Please cite specific passages, pages, etc. _

3. Is you objection to this material based upon your personal exposure to it, upon reports you have heard, or both? _

4. What do you believe is the theme or purpose of the material? _

__5. What do you feel might be the result of reading/viewing the work?__ _

6. In its place, what work of equal value would you recommend that would convey as valuable a picture and perspective of a society or a set of values? _

__7. Do you wish to make an oral presentation of 15 minutes or less to the Materials Review Committee?__

_ Signature Date

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