CITIZEN'S REQUEST FOR CONSIDERATION OF A BOOK

Author Hardcover Paperback ________________________________

Title ________________________________________________

Publisher (if known) ______________________________________

Request Initiated by Telephone _______________________________

Address City Zip Code ______________________________________

Complainant Represent: ______________________________________

Himself ___________________________________________________

Name of Organization ________________________________________

Identify Other Group _________________________________________

1. To what in the book do you object? (Be specific, cite pages)

2. What do you feel might be the result of reading this book?

3. For what age group would you recommend this book?

4. Is there anything good about this book?

5. Did you read the entire book? What parts?

6. Are you aware of the judgment of this book by literary critics?

7. What do you believe is the theme of this book?

8. What would you like your school to do about this book?

Do not assign it to my child

Withdraw it from all students as well as from my child

Send it back to the English Department Office for reevaluation

9. In its place, what book of equal literary quality would you recommend that would convey as valuable a picture and perspective of our civilization?

_____________________________________________
Signature of Complainant