- Section I: Instruction
IJJ-E - CITIZEN’S CHALLENGE TO EDUCATIONAL MEDIA
(Refer to School Board Policy IJJ)
Type of Material: ____ Book ____ Magazine/Periodical ____ Film ____ Recording
____ Software ____ Other (Please specify)___________________________________________
Author (if known): ___________________________________________________________________________________
Title: ______________________________________________________________________________________________
Publisher (if known): _________________________________________________________________________________
Person making complaint: _____________________________________________________________________________
Telephone ________________ Street Address ____________________________________ Town____________________
Complainant represents: ⃞ Him/herself
⃞ Organization ________________________
⃞ Other group ________________________
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Why do you object to this material?
____________________________________________________________________________________________
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Identify any particular sections to which you object. (Please be specific, cite pages, scenes, etc.)
____________________________________________________________________________________________
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What are the positive aspect of this material?
____________________________________________________________________________________________
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Did you read/view/hear all of the material? ________ If not, what parts did you read/view/ hear? ____________________________________________________________________________________________
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Please identify any professional reviews/judgements of this material you have read.
____________________________________________________________________________________________
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What would you like the school to do about this material?
- ⃞⃞ Restrict use of the material Do not assign it to my child.
- ⃞⃞ Do not assign it to any students.
- ⃞⃞ Withdraw it from the library and/or instructional program.
- ⃞⃞ Refer it to the Educational Media Review Committee for evaluation.
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In its place, what material would you recommend? _____________________________________________________
_______________________________________________________________________________________________
__________________________________________ ______________________
Signature of Complainant Date
- Section I