Patron’s Request For Reconsideration of Library Resource

Patron’s Request For Reconsideration of Library Resource

The Elsie Public District Library Board of Trustees has delegated the responsibility for selection and evaluation of library resources to the Library Director and has established reconsideration procedures to address concerns about those resources. Completion of this form is the first step in those procedures. If you wish to request reconsideration of library resources, please return the completed form to the Library Director.

Your Name: ____________________________________________ Date: _______________

Address: ___________________________________________________________________

City/State/Zip: _______________________________________________________________

Phone: _________________________

Please answer the following questions (Y or N). Please be advised that both conditions must be met for your request to proceed.

Are you 18 years of age or older? _______

Do you live in Clinton County? _________

Did you read, view, or listen to the ENTIRE work? _______

Title of Item: _______________________________________________

Author/Composer/Director: ___________________________________

Format (circle one)

Book     CD      Video      Magazine      Audio Recording      Newspaper        Electronic Resource

What brought this resource to your attention?

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What concerns you about this resource?

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Admin use only

__________ Rec’d date by ____________________________________

__________ Receipt letter sent to patron

__________ Item reviewed date by _______________________________________________

__________ Library response completed by _______________________________

__________ Meeting date with patron __________ Meeting summary completed