Tuolumne COE | E 1312.2 Community Relations
Complaints Concerning Instructional Materials
REQUEST FOR RECONSIDERATION OF INSTRUCTIONAL MATERIALS
This form is for use only by district employees, district residents, or parents/guardians of children enrolled in a district school/program site to challenge the content or use of an instructional material. For complaints regarding sufficiency of instructional materials, please use the Williams Uniform Complaint Procedure complaint form.
Please check the type of materials:
( ) Book ( ) DVD ( ) Other
( ) Periodical ( ) Audiocassette
( ) Pamphlet ( ) Videocassette
Name of person filing complaint:________________________________________________
Anonymous complaints will not be accepted.
Group represented (if any):____________________________________________________
Phone:__________________________ E-mail address, if any:________________________
Material Being Challenged:
Publisher: Date of Edition:
Name of school/classroom material was used:______________________________________
1. Please specifically state the nature of your concern or objection and identify your objection by page, tape sequence, video frame, or words, as appropriate. You may use additional pages if necessary.
2. Did you read/view the entire selection?
3. If not, what percentage did you read/view, or what parts?
4. For what age group would you recommend this material?
5. What do you feel might be the result if a student reads/views this material?
6. What are the good aspects of this material? __________________________________
What is your objection to having this material available for use in the schools in Tuolumne County?
6. What would you like the school/program site to do about this material?
? Do not assign it to my child
? Withdraw it from all students
? Reconsider it
Signature of complainant
For County Office Use:
Request received by: Date:
Action taken: Date:
Exhibit TUOLUMNE COUNTY SUPERINTENDENT OF SCHOOLS
version: May 30, 2008 Sonora, California