Request for Reconsideration of Library Materials Form

DATE: _______________________________

The Hawkins County Library System Board of Trustees has authorized this form.  Please return this form to the Director of the Hawkins County Library System, 407 E. Main Street, Suite 1, Rogersville, TN  37857

Material for Consideration

Author/Producer:___________________________________________________

Publisher:_________________________________________________________

Title:_____________________________________________________________

Dewey number (if any):______________________

Date/Edition:___________________

Type of Material:

____Book      _____Magazine/Newspaper   _____Video/DVD/CD

_____Electronic Database    ____Audio/CD

Other:___________________________________________________

 

Did you read, view or listen to the entire work or a portion of the work?

___All  ____Part

 

Please describe your concerns regarding this material:

 

What specific pages/sections illustrate your concerns:

 

How did this material come your attention (optional):

 

CONTACT INFORMATION

NAME: ______________________________________________________

ADDRESS: ____________________________________________________________

CITY/STATE: _________________________________________________

ZIP: ___________________________

ORGANIZATION REPRESENTED: ________________________________

TELEPHONE:  ________________________________________________