Questioned and Challenged Materials

Author

Title

Publisher

Publication date

Request initiated by

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Email

Local school district

Complainant represents self

Name of organization or other members of group

Please answer the following questions.

1) Have you examined the material in its entirety?

If not, what parts did you examine?

2) What is objectionable in this material?

3) What knowledge and behaviors do you think will result from studying this material?

4) What do you feel might be the result of using this material with children?

5) For what age group would you recommend this material?

6) Did you view or hear the entire material?

If not, which parts?

7) Are you aware of the judgment of this material by literary critics?

8) What do you believe is the theme of this material?

9) What is your request for resolution of this challenge?

10) What material of equal educational quality would you recommend to replace this item?

Signature

Date

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