Appendix II - Request for Re-evaluation of a Learning Resource
Name _________________________________________ Date _____________________
City __________________________________________ Postal Code _______________
Do you represent yourself? ______ Organization (name) __________________________
Learning Resource in Question:
Please respond to the following questions. If sufficient space is not provided, you may attach additions to this form.
How did this learning resource come to your attention?
Have you read/heard/seen this learning resource in its entirety? Yes _____ No ___
If you have indicated No above, what parts of the resource have you read/heard/seen?
To what do you object? Please be specific with your concerns – cite pages, passages, etc.
What do you believe is the main idea of this learning resource?
What do you feel might result from the use of this learning resource?
What do you consider the positive qualities of this learning resource?
Are you aware of the judgment of this learning resource by professional reviewers or professional educators?
For what age group would you recommend this resource?
What action do you recommend that the school take with regard to this learning resource?
_____ withdraw or exempt it from use by my child
_____ withdraw or exempt it from all students
_____ submit it to a re-evaluation committee for re-evaluation
Are there resource(s) you can suggest to provide additional information and/or other viewpoints on this topic?
Name (print please) ___________________________________
Reviewed July 2010