IJJ-E1 - Challenge of Instructional Materials Form
Challenge of Instructional Materials Form - IJJ-E1
Type of Material:
_____ Book _____ Magazine/Periodical _____ Film/DVD _____ Internet/Digital Resources ____ Software
Other (Please specify) ______________________________________________________________________
_________________________________________________________________________________________
Title ____________________________________________________________________________________
Publisher (if known) _______________________________________________________________________
Person making complaint: ___________________________________________________________________
Telephone ______________________________________Email _____________________________________
Address __________________________________________________________________________________
Complainant represents: ___ Him/herself
___ Group/Organization ______________________________________________
- To what portion of the material do you object? (Please be specific, cite pages, scenes, etc.) _________________________________________________________________________________
- What do you feel might be the negative result of reading/viewing/hearing this material? _________________________________________________________________________________
- For what age group would you recommend this material? __________________________________
- Is there anything good about this material? ______________________________________________
- Did you read/view/hear all of the material? ____________If not, what parts did you read/view/ hear? _________________________________________________________________________________
- Are you aware of the professional reviews/judgment of this material? _________________________
- What do you believe is the theme and/or intention of this material? ___________________________
- What would you like the school to do about this material?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
- In its place, what material would you recommend? ___________________________________________
_____________________________________________________________________________________
__________________________________ _____________________
Signature of Complainant Date