Request for Reconsideration of Library Materials

---

REQUEST FOR RECONSIDERATION
Converse Free Library
38 Union Street, Lyme, NH  03768

Please complete this form if you have a concern about an item in the library≠s collection.  The form should be returned to the Library Director.  Library policy states that the Director must respond in 10 days.

Name ___________________________
Date ___________________________
Address ___________________________
City ___________________________
State ___________________________
Zip ___________________________
Phone ___________________________
Do you represent self? ____               Organization? ____

Resource on which you are commenting:
Title ___________________________
Author/Producer ___________________________
Format (Book, video, audio, etc.)

What brought this resource to your attention?


Have you read, viewed or listed to the entire work?

What do you believe is the theme of this work?


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?








Revised by the American Library Association, 1995


Passed 9/2008