Reconsideration of a Library Material Form

Harmony Public Library

225 3rdAve. SW

P0 Box 488

Harmony, MN 55939

Request for Reconsideration of Library Material

By completing this form, you are asking that the Library reconsider its selection of a book or other item for the Library collection. When received, the Library Board and staff will study reviews, read the material and prepare a recommendation about the item. You will receive a letter containing this recommendation. You may then request a conference with the Library Board and staff to discuss the material and the written recommendation.


Your Name __________________________________________________________________________

Address ____________________________________________________________________________


The Book or Item You Wish to be Reconsidered

Author ____________________________________________________________________________

Title ____________________________________________________________________________

Publisher ___________________________________________________________________________

Date Published ________________________________________________________________________

Did you check this book or item out of the library? _____Yes _____No

Was the person who borrowed the book: _____an adult _____a young adult (Junior High or Senior High School Age) _____a Juvenile (Elementary School Age) _____a preschooler?

Was it chosen by the person who was to read it? ___Yes _____No

Did you read the whole book? _____Yes _____No

Please state your reason for asking for reconsideration of the item in the Library collection. (Use the back of this form in needed)

What action do you suggest the library take in regard to this material?


Staff member receiving initial complaint:


Date: __________________________