Collection Management Policy - Request for Reconsideration Form

2. Please describe the item in question as fully as possible. You may attach extra pages if  necessary.

4. Title*
6. Author*
8. Format (check one):*

   1. Book

   1. Book on CD

   1. DVD

   1. Other
10. Publisher and Copyright Date*

12. Please answer the following questions:

14. What is the subject of the item?*
15. Have you read, listened to, or viewed the item in its entirety?*

    1. Yes
    2. No
17. Do you have any additional information, including reviews, articles, etc.? (Please cite source, date, and page.) Please applicable information.
19. Please state the action you wish taken on this item:*

    1. Add to the Library
    2. Shelve Elsewhere
    3. Remove From the Library
    4. Other
20. If you responded with 'other', please specify here.
22. What are your reasons for this request?*
24. Please explain how such an action would improve the Library service to the community:*
26. What are the positive points of the material?*
28. Do you feel the material is objectionable to all patrons, or some patrons?*
30. If you wish for the material to be withdrawn from the Library entirely, what material of equal literary merit would you recommend in its place?*
32. First Name*
33. Last Name*
35. Phone Number*
36. Email Address*
38. Address*
40. City*
41. State*
42. Zip Code*
44. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
46. Electronic Signature
50. (Optional) I am acting as a spokesperson for the following group or association:
52. Contact Person:
53. Telephone number:
55. Add Attachments Here
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field