Statement of Concern about Resources
Southwestern Consolidated Schools
Name: __________________________________________________ Date: ________________
Connection to SW: _____________________________________________________________
Address: ______________________________________________________________________
City: __________________________________________ State: ______ Zip: _______________
Phone: _______________________________________________________________________
Email: ________________________________________________________________________
School of resource: SWE ____________ SWHS ___________
Title of resource in question: ______________________________________________________
Format (book/magazine/newspaper/AV resource/digital resource/library program/other):
______________________________________________________________________________
Author/Publisher/Artist: __________________________________________________________
What objections do you have with this item? Be as specific as possible.
_____________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________
Other comments on the item’s content (both positive and negative):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Did you read/view the entire item? __________ Yes _________
No If no, on what parts did you base your opinion?_____________________________________
______________________________________________________________________________
What audience do you believe this item was intended for? _______________________________
______________________________________________________________________________
What do you want the library to do with this item?
______________________________________________________________________________
______________________________________________________________________________
If this item were to be removed from the collection, do you have a suggestion for an item of
equal or better quality to replace it?
______________________________________________________________________________
______________________________________________________________________________
Additional comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please understand that the Southwestern Consolidated Media Centers are governed by the rights
inherent in the First Amendment of the Constitution of the United States, the American Library
Association’s Bill of Rights, and the Freedom to Read Statement developed jointly by the
American Library Association and the Association of American Publishers