MERCER COUNTY LIBRARY SYSTEM
CITIZEN'S REQUEST FOR RECONSIDERATION OF LIBRARY MATERIALS

TYPE OF MATERIAL: Book, Cassette, Record, Compact Disc, Videotape, DVD, 
CD-ROM, Film, Filmstrip, Pamphlet, Magazine (circle one)

AUTHOR: ______________________________________________________________

TITLE: _________________________________________________________________

PUBLISHER (if known): ___________________________________________________

REQUEST INITIATED BY:
STREET ADDRESS: ___________________________________________________

CITY/TOWN: ________________________STATE: ________ ZIP CODE: ___________

TELEPHONE NUMBER: ____________________________________________________

COMPLAINANT REPRESENTS: ______________________________________________

1. To what in this title do you object? (Please be specific; cite pages, parts or scenes)
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2. For what age group would you recommend this title? _________________________

3. Is there anything good about this title? ___________________________________

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4. Did you read/view/listen to the entire work? ________________________________

5. Are you aware of reviews of this title by professional critics? ____________________

6. What do you believe is the theme of this work? _____________________________

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7. What would you like your library to do about this title? ________________________

8. Other comments: ____________________________________________________

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