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2. Request for Reconsideration Form
4. Date
5. Name
7. Library Card Number
9. Address
11. City
12. State
13. Zip Code
15. Phone
16. Email
18. Do You Represent

    1. Yourself
    2. An Organization
19. Name of Organization (if Applicable)
21. Resource on Which You Are Commenting
23. Title
24. Author/Producer
26. Library Barcode (if Applicable)
28. 1. What Brought This Resource to Your Attention?
30. 2. Have You Examined the Entire Resource? If Not, What Sections Did You Review?
32. 3. What Concerns You About the Resource?
34. 4. Are There Resources You Suggest to Provide Additional Information and/or Other Viewpoints on This Topic?
36. 5. Have You Read the Library's Collection Development Policy?

    1. Yes
    2. No
38. 6. What Action Are You Requesting the Committee to Consider?
40. Signature
41. Date
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

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