Title________________________________________________ Book____ Magazine____ Other____


Request Initiated By (name) ___________________________________________________________


City___________________________________ State_________ Zip_______ Phone_______________

Do you represent: Self___________ or Organization and Group______

Name of Organization or Group_________________________________________________________

  1. How was the material brought to your attention?

  2. Did you read or view the entire work?_______ What parts?________________________________

  3. To what do you object in the work? Please be specific. Cite pages, specific scenes or passages, etc.

  4. What do you feel might be the result of reading/viewing this work?

  5. What review sources or other information have you used in evaluating this work?

  6. For what patrons is this material inappropriate or objectionable?

  7. Is there anything good about this work when it is considered as a whole?

  8. What do you believe is the theme of the work or the intention of the author/producer?

  9. What would you request that the materials review committee do about the work?

    _____Re-Evaluate for Placement in the Collection ___Other --Explain.

  10. Additional comments:

Please use additional space as required.

Signature__________________________________________________ Date__________

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Mail to: Library Director
Hall County Library System
127 Main Street NW
Gainesville, Georgia 30501

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