Request for Reconsideration of Learning Resources


Name ____________________________________ 

Date ________________

Address __________________________________

City _________________

State ________________

Zip __________________

Phone _______________

Do you represent self? ____   Organization? ____


Resource on which you are commenting:

____ Book ____ Video ____ Display

____ Magazine ____ Library Program

____ Newspaper ____ Electronic information/network (please specify)

____ Other ___________________________

Title ___________________________

Author/Producer ___________________________


What brought this resource to your attention?



Have you examined the entire resource?



What concerns you about the resource? (use other side or additional pages if necessary)



Are there resource(s) you suggest to provide additional information and/or other viewpoints on this topic?