TOWN OF TEWKSBURY
300 CHANDLER STREET
TEWKSBURY, MASSACHUSETTS 01876

TEWKSBURY PUBLIC LIBRARY

(978) 640-4490
FAX (978) 851-8609

Appendix A:

Request for Reconsideration of Library Materials

Title: _________________________________________________________________________

Author(s): _____________________________________________________________________

Publisher: ____________________________________ Copyright date: ________________

Format (i.e. book, DVD, etc.): __________________________________________________

Please state the action you would wish to be taken on this item:

What is your objection to the material? Feel free to use the back of this form if needed.

Have you read/viewed/listened to the entire work? If not, then which parts (please specify page numbers, chapters, scenes, song titles, etc.)?

How was this material brought to your attention?

Name: ________________________________________________________________________

Address: ______________________________________________________________________

Home Phone: ________________________ Work Phone: ______________________________

Signature: ___________________________________________ Date: _______________________

Approved by the Board of Library Trustees, March 7, 2005