You are here

622 RECONSIDERATION OF INSTRUCTIONAL MATERIALS RECONSIDERATI0N REQUEST FORM

Request for re-evaluation of printed or multi-media material to be submitted to the superintendent

 

 

 

Review Initiated By:                                                                            Date:_______________

 

Name:______________________________

 

Address:________________________________________

 

 

City/State:____________________   Zip Code:_______________

 

Telephone:_______________

 

 

 

School(s) in which item is used:________________________________________

 

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

 

Book or Other Printed Material, If Applicable:

 

 

 

Author:____________________        Hardcover:_____        Paperback:_____       Other:_____

 

 

 

Title:________________________________________

 

Publisher:________________________________________

 

Date of Publication:________________________________________

 

Multimedia Material, If Applicable:

 

Title:________________________________________

 

Producer:________________________________________

 

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

 

Person Making the Request Represents: (circle one)

 

 

Self                              Group or Organization           

 

Name and Address of Group or Organization:_________________________________________

 

 

 

 

 

1.  What brought this item to your attention?

 

 

 

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

 

 

 

6.  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?

 

Yes _____       (a)        Please contact the Superintendent

 

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

 

Minutes __________

 

No _____

 

 

The committee will review your request and notify you if your request is granted; however, there is no guarantee that each and every request will be granted, either in terms of appearing before the committee or in receiving the amount of time requested.

 

 

 

 

Signature:_______________________________                  Date:____________________ 

 

First Reading Approved 12/19/18                                                              Second Reading Approved 1/21/19