605.3E2 Reconsideration of Instructional Materials Reconsideration Request Form

Code No. 605.3E2

RECONSIDERATION OF INSTRUCTIONAL MATERIALS
RECONSIDERATION REQUEST FORM

Lisa

Request for re-evaluation of printed or multimedia material to be submitted to the superintendent.

REVIEW INITIATED BY:_______________________________    DATE: ________________

Name ________________________________________________________________________

Address_______________________________________________________________________

City/State_________________________Zip Code____________Telephone ________________

School(s) in which item is used____________________________________________________

Relationship to school (parent, student, citizen, etc.)____________________________________

BOOK OR OTHER PRINTED MATERIAL IF APPLICABLE:

Author________________________Hardcover_______Paperback________Other____________

Title__________________________________________________________________________

Publisher (if known)_____________________________________________________________

Date of Publication______________________________________________________________

MULTIMEDIA MATERIAL IF APPLICABLE:

Title__________________________________________________________________________

Producer (if known)_____________________________________________________________

Type of material (filmstrip, motion picture, etc.)_______________________________________

PERSON MAKING THE REQUEST REPRESENTS: (circle one)

____Self                 ____Group or Organization

Name of group _____________________________________________________

Address of Group___________________________________________________

1.  What brought this item to your attention?

    ______________________________________________________________________

    ______________________________________________________________________

2.  To what in the item do you object? (please be specific; cite pages, or frames, etc.)

    ______________________________________________________________________

    ______________________________________________________________________

3.  In your opinion, what harmful effects upon students might result from use of this item?

    ______________________________________________________________________

    ______________________________________________________________________

4.  Do you perceive any instructional value in the use of this item?

    ______________________________________________________________________

    ______________________________________________________________________

5.  Did you review the entire item? If not, what sections did you review?

    ______________________________________________________________________

    ______________________________________________________________________

6.  Should the opinion of any additional experts in the field be considered? ____yes ____no If yes, please list specific suggestions:

    ______________________________________________________________________

    ______________________________________________________________________

7.  To replace this item, do you recommend other material which you consider to be of equal or superior quality for the purpose intended?

     ______________________________________________________________________

    ______________________________________________________________________

8.  Do you wish to make an oral presentation to the Review Committee?

___________Yes     

1. Please contact the Superintendent
2. Please be prepared at this time to indicate the approximate length of time your presentation will require. Although this is no guarantee that you'll be allowed to present to the committee, or that you will get your requested amount of time. ________________________Minutes.

___________No
 

________________        ____________________________________
Dated                               Signature

Approved: 2/8/17, Reviewed: 6/14/23, Revised: 
Grinnell-Newburg School District, Grinnell, IA