Descriptor Code: GAAC-BR
Request initiated by __________________________________________________________
Telephone ___________________ Address ________________________ City __________________
Complainant represents: Oneself _________ or Organization _________
Author _____________________________ Type of Material ________________________________
Title ______________________________________________________________________________
Publisher (if known) _________________________________________________________________
What is the school use of this material, ( ie. Required reading, library, etc. )
1. To what in the material do you object: (Please cite specifics and pages)
2. What do you feel might be the result of using this material?
3. For what age group would you recommend the material?
4. Is there any educational value in this material?
5. Did you review the entire material?
6. Are you aware of reviews of this material by literary critics: ( Please attach such reviews)
7. What would you like your school to do about this material?
Do not assign it to my child. __________
Withdraw it from all students as well as my child. ___________
Date ____________________
Signature of Complainant ________________________________________________
Request initiated by __________________________________________________________
Telephone ___________________ Address ________________________ City __________________
Complainant represents: Oneself _________ or Organization _________
Author _____________________________ Type of Material ________________________________
Title ______________________________________________________________________________
Publisher (if known) _________________________________________________________________
What is the school use of this material, ( ie. Required reading, library, etc. )
1. To what in the material do you object: (Please cite specifics and pages)
2. What do you feel might be the result of using this material?
3. For what age group would you recommend the material?
4. Is there any educational value in this material?
5. Did you review the entire material?
6. Are you aware of reviews of this material by literary critics: ( Please attach such reviews)
7. What would you like your school to do about this material?
Do not assign it to my child. __________
Withdraw it from all students as well as my child. ___________
Date ____________________
Signature of Complainant ________________________________________________