Request for Reconsideration Form

Date

Name

First Name

Last Name

Address

City

State/Province

Zip/Postal

Email address or phone number (both are preferred)

Note: This request will become public record when it is shared by the Library Director with the Library System Board of Directors at the conclusion of this formal process. Your name will be included in the record, but all other contact information will be redacted.

This request is for reconsideration of a

Book/Magazine

DVD or Film

Library Event

Exhibition

Electronic Information

Display

Other (brief description)Other (brief description)

Title

Name of author, artist, contributor, presenter

Location of item or event

Please specify what concerns you about the resource/event/exhibition/display and why. (You may attach additional information or files)

File Upload

Maximum file size: 134.22MB

Please select the resolution you are requesting

Remove material or resource from library holdings

Shelve or link the material or resource elsewhere

Discontinue event, exhibition, or display

OtherOther

Please explain how such a resolution might improve the library’s service to the community. (You may attach additional information or files)

File Upload

Maximum file size: 134.22MB

Are there other resources you believe would provide information and/or other viewpoints on this topic? (All suggestions will be considered based on relevant LCLS policies.)

By checking this box, you acknowledge that you are the person named on this form and your request meets the eligibility requirements.

I agree