6:230-AP, E Library Media Resource Objection Form
Use this form to submit feedback and/or complaints about the District’s library media resources. Please complete this form and return it to the Building Principal, who will submit it to the Superintendent or designee. Please print.
| Book/Library Resource Title | School |
Please explain why you object to this library resource and state your desired outcome, if any. Please be specific.
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| Complainant name (please print) | Telephone Email Address | |||
| Complainant represents: | Student [ ] | Parent/guardian of student [ ] | ||
| Other [ ] | ||||
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| Complainant address | ||||
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| Complainant signature | Date | |||
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Completed by the Superintendent or designee.
Written response provided to Complainant on: ____________________ (attach response to this form)
Superintendent or Designee Signature __________________________________ Date _________________
Date Adopted: June 20, 2023
