Request for Reconsideration of Library Materials

ONE FORM PER TITLE/ITEM FOR RECONSIDERATION

Only completed forms from Fox Lake Public Library (FLPL) cardholders, whose primary residence is in the City of Fox Lake or a non-libraried area of Dodge County, Wisconsin, will be reviewed.
This form becomes a public document and the person(s) filling out this form waives their right to anonymity under Section 43.30 of the Statutes.

Your Name (Please Print) ___________________________________________Today’s Date________
Street Address______________________________________________________________________________ Phone________________________ Email ____________________________________________________
I attest that the address listed above is my primary residence. Signature_______________________________


I have read all six (6) policies and statements listed in 7(e) of the library’s Materials Collection Policy. Y ( ) N ( )
Who do you represent? Yourself ( ), OR an organization ( )
Name of organization__________________________________
Exact Title of Item _____________________________________________________________
Author_____________________________________________ Edition/Publication Date________________
Format: Book/Audio Book ( ) DVD/Blu-Ray ( ) Music ( ) Other_______________________________________

Please answer all the following questions. Use separate sheet(s) if necessary.

  1. How did you learn about this material?
  2. What are your objections to this material? Cite pages if applicable.
  3. What do you feel might result from reading, viewing or listening to this material?
  4. What is good about this material?
  5. Did you read, view or listen to the entire title in question? If not, which parts did you read, view or
    listen?
  6. What do you think is the purpose of this work?
  7. Have you read any professional reviews of this work? If so, please list the names of critics and sources
    of reviews.
  8. What alternative title(s) with a similar purpose/viewpoint would you suggest in place of this work?
  9. What would you like to see done to resolve this situation?

LIBRARY USE ONLY
FLPL card holder Y ( ) N ( ), Primary Residency verified Y ( ) N ( ), Item owned by FLPL Y ( ) N ( )

Step 1: The Library Director will arrange a conference to discuss this material with the patron in an attempt to reach a mutual agreement. If an agreement is reached, the report is signed, dated, and forwarded to the President of the Library Board. If satisfaction is not gained, continue with Step 2.
Explain the agreement reached ______________________________________________________________________

Patron Signed_____________________________________________________________ , Date __________________
Director Signed____________________________________________________________ , Date __________________

Step 2: Meet with the Library Board.
Date of Library Board meeting for review ______________________________________________________________
Final Library Board Decision made on Date _____________________________________________________________

Keep as is ( ), Relocate to___________________________ ( ), Remove from Collection ( ) Relocate/Removal Date _______