ALLEGHANY COUNTY SCHOOL DIVISION

REQUEST FOR RECONSIDERATION OF LEARNING RESOURCES

 

Request By


Representing


Myself

 


Organization or Group

(please identify)


Telephone


E-mail address


Address


How do you prefer to be contacted?


Title or Description of Item


Author or Editor


Type of Material

(book / film / record / speaker / software / other (specify))


 

  1. Did you examine, review, or listen to this learning resource or presentation in its entirety?

qYES†††††††††††††††††††††† qNO

 

  1. Have you discussed this material with school staff who ordered it or who use it?

qYES†††††††††††††††††††††† qNO

 

If yes, please identify the staff person(s) with whom you had the discussion:

_____________________________________________________________

††††††††††††††††††††††††††††††††††† [Print name of staff person(s)]

 

3.†††† Are you aware of evaluations of this material by professional critics?

qYES†††††††††††††††††††††† qNO

 

If no, would you be interested in receiving this information?

qYES†††††††††††††††††††††† qNO

 

  1. Describe what prompted your concern about the material.Please cite page numbers and/or specific information from the material to support your concerns (attach additional material, if necessary).

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

  1. Does the general purpose for the use of the material, as described by the school staff or in the Alleghany County school divisionís program objectives, seem a suitable one for you?

qYES†††††††††††††††††††††† qNO

 

If not, please explain (attach additional material, if necessary)

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

  1. What action[s] would you like to see the school take regarding this material?

qDo not assign it to my child†††††††††† ††††††††††† qThe school should reevaluate the material

 

qOtheróExplain:__________________________________________________________

____________________________________________________________________________________________________________________________________________________

  1. Are there other materials of the same subject and format that you would suggest for consideration in place of this material? qYES†††††††††† qNO

 

If yes, please identify your suggestions.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

††††††††††† Signature ______________________________†††††† Date__________________

 

RETURN COMPLETED FORM TO SCHOOL PRINCIPAL