IJJ-E challenge of instruction materials form INSTRUCTIONAL AND LIBRARY-MEDIA MATERIALS CHALLENGE FORM Type of Material: ____ Book ____ Magazine/Periodical ____ Film ____Recording ____ Software ____ Other (Please specify) _______________ Author (if known) _____________________________________________________________ Title ________________________________________________________________________ Publisher (if known) ___________________________________________________________ Person making complaint: _________________________________________________________ Telephone ____________ Street Address _____________________________ Town ____________ Complainant represents: ___ Himself/herself/themself ___ Organization ________________________ ___ Other group ________________________ To what portion of the material do you object? (Please be specific, cite pages, scenes, etc.) __________________________________________________________________ What do you feel might be the negative result of reading/viewing/hearing this material? ______________________________________________________________________ For what age group would you recommend this material? ________________________ Is there anything good about this material? ___________________________________ Did you read/view/hear all of the material? __________________ If not, what parts did you read/view/ hear? ____________________________________________________ Are you aware of the professional reviews/judgment of this material? _______________ What do you believe is the theme and/or intention of this material? _________________ What would you like the school to do about this material? ___ Do not assign it to my child. ___ Do not assign it to any students. ___ Withdraw it from the library and/or instructional program. ___ Refer it to the Educational Media Review Committee for evaluation. In its place, what material would you recommend? _____________________________ Signature of Complainant Date Checklist for Reconsideration of Materials Purpose: What is the overall purpose of the material? Is this purpose accomplished? Does the material promote the educational goals and mission of RSU 1? Authenticity: Is the author competent and qualified in the field? What is the reputation and significance of the author and publisher? Are information sources well documented? Are translations and retellings faithful to the original? Content: Is the content of this material well presented by providing adequate scope, range, depth and continuity? Does this material present information not otherwise available? Are the illustrations appropriate to the subject and age levels? Reviews: Reputable review sources include: School Library Journal, Hornbook, Kirkus Reviews, VOYA, Booklist and Library Media Connection. Source of Review: Favorably reviewed? Unfavorably reviewed? Does this title appear in one or more reputable selection aids? If the answer is yes, please list titles of selection aids. Source of Second Review: Favorably reviewed? Unfavorably reviewed? Does this title appear in one or more reputable selection aids? If the answer is yes, please list titles of selection aids.