Antelope Valley Union HSD | E 1312.2 Community Relations
Complaints Concerning Instructional Materials
CITIZEN'S REQUEST FOR RECONSIDERATION OF INSTRUCTIONAL MATERIALS
Date:_________________________________
TITLE:
AUTHOR:
PUBLISHER: DATE OF EDITION:
Request received by: Title:
Citizen's Name: Phone:
Citizen Represents: Himself/Herself: Organization or Group:
1. To what do you object? (Please be specific: cite pages, tape sequence, video frame, and words)
2. What do you feel would be the result of reading/viewing this material?
3. For what age group would you recommend this material?
4. Did you read/view the entire selection?
5. If not, what percentage did you read/view, or what parts?
6. Is there anything good about this material?
7. What would you like the school to do about this material?
___ Do not assign it to my child.
___ Withdraw it from all students.
___ Re-evaluate it.
8. Are you aware of how this work has been assessed by literary critics?
9. What do you believe is the thesis of this work?
10. In its place, what work would you recommend?
Signature of citizen
Action taken: _____________________________ Date: ______________________________
Exhibit ANTELOPE VALLEY UNION HIGH SCHOOL DISTRICT
version: November 13, 1990 Lancaster, California