Lancaster SD | E 1312.2 Community Relations
Complaints Concerning Instructional Materials
CITIZEN'S REQUEST FOR RECONSIDERATION OF INSTRUCTIONAL MATERIALS
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 LANCASTER SCHOOL DISTRICT
version: November 6, 2007 Lancaster, California