Title:

Book             Periodical            Other

Author: 

Publisher: 

Request Initiated By: 

Address:

Telephone:     E-Mail: 

Do you represent:
Yourself

An organization (Name) 

Other group (Name)      

To what in the work do you object? (Please be specific.  Cite pages.)

Did you read the entire work?  What parts?

What do you feel might be the result of reading this work?

What do you believe is the theme of this work?

Are you aware of judgments of this work by literary critics?

What would you like your library/college to do about this work?
Return it to staff selection committee/department for reevaluation.
Other.  Explain:

In its place, what work would you recommend that would convey as valuable a picture and perspective of the subject treated?

Signature: 

Date: