Bibliographic description of challenged material:
Author, Editor, Artist, etc. ____________________________________________________________
Title: ______________________________________________________________________________
City of Publication: __________________________________________________________________
Publisher: __________________________________________________________________________
Copyright: _________________________________________________________________________
Justification for inclusion of material: (Include theme and purpose.)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Critics judgment of material: (If possible include copies of reviews indicating the source.)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Materials Evaluation Committee's decision and comments:
(Include statements from majority and minority positions.)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Copies sent to: _______________________________________________________________________
_______________________________________________________________________
Signatures of Committee Members: Date:
______________________________________________________ ________________
______________________________________________________ ________________
______________________________________________________ ________________
______________________________________________________ ________________
______________________________________________________ ________________
______________________________________________________ ________________
Superintendent________________________________________ ________________
Administrative Supervisor______________________________ ________________
Complainant__________________________________________ ________________