Sample Reconsideration Form

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THE [NAME] LIBRARY WISHES TO THANK YOU FOR YOUR INTEREST IN THE LIBRARY AND ITS RESOURCES. THE LIBRARY TAKES VERY SERIOUSLY ALL CONCERNS EXPRESSED BY PATRONS AND ATTEMPTS TO RESPOND AS QUICKLY AS POSSIBLY. TO ENSURE THAT YOUR CONCERN IS GIVEN CAREFUL CONSIDERATION, THE REVIEW PROCESS MAY TAKE AS LONG AS [TIME].

RETURN FORM TO: [LIBRARY NAME AND ADDRESS]

* * * * * * * * * * * * * *

 

DATE ________________________________ TELEPHONE ____________________________

 

YOUR NAME __________________________________________________________________

 

ADDRESS ____________________________________________________________________

 

CITY ______________________ STATE __________ ZIP CODE _________________________

 

1. TYPE OF MATERIAL ON WHICH YOU ARE COMMENTING:

 

        BOOK             SOUND RECORDING

 

        MAGAZINE         LIBRARY PROGRAM

 

        NEWSPAPER        ELECTRONIC RESOURCE

 

        DVD              OTHER _____________________________________________________

 

     TITLE _______________________________________________________________________

 

     AUTHOR/PRODUCER ___________________________________________________________

 

2. WHAT BROUGHT THIS RESOURCE TO YOUR ATTENTION?

 

3. PLEASE EXPLAIN YOUR CONCERN AS SPECIFICALLY AS POSSIBLE.

 

OPTIONAL

4. WHAT RESOURCE DO YOU SUGGEST TO PROVIDE ADDITIONAL INFORMATION ON THIS TOPIC?

 

 


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