Monroe County Public Library * 303 E. Kirkwood * Bloomington, IN 47408 * 812-349-3050
Please print except for signature. Attach additional pages as necessary.
Patron Name (please print): _________________________________________ Date:____________
Address: _____________________________________________ Zip: ________________________
Phone Number:_______________________ Email:________________________________________
Do you represent an organization? Yes_____ No_____
If yes, what organization? ________________________
Media Type (please circle one):
___Audiobook ___Book ___DVD ___Magazine ___Audio CD ___Other_______________
Call Number:______________________________ Copyright Date:____________________
1. How did this material come to your attention?
2. Did you read/listen/view this material completely? __ Yes __ No
3. In your view, what is the topic or theme of this material?
4. What is your objection to the material? Be as specific as you can; list page numbers as appropriate.
5. Did you find something good or worthwhile about this material? ___ Yes ___ No
If yes, what?
6. What age group do you think the material is appropriate for?
7. What action would you like taken regarding this material?
8. Are there other materials you recommend to provide additional information or points of view on this topic? (Attach another page as needed.)
Thank you. Your request will be reviewed by the Library Director for action.
FOR STAFF USE ONLY
Status Report on Patron Request for Reconsideration of Library Material
|Name of staff member initially contacted by patron: ________________________|
|Reconsideration form returned to library and copy sent to appropriate department manager. Original form sent to Library Director.|
|Library patron contacted by Library Director and informed of reconsideration process.|
|Chair of Collection Development Committee forms Reconsideration Committee in consultation with Library Director.|
|Reconsideration Committee meets, researches the material, and discusses request.|
|Decision of Reconsideration Committee sent to Library Director.|
|Library Director informs patron by letter of the library’s decision.|
|Copies of Director’s letter are sent to members of the Reconsideration Committee and to the Library Board of Trustees.|
|Signature of Library Director: ____________________________ Date:_________|