File: IJJ-E – Request for Reconsideration of Instructional Materials

Download File: IJJ-E

M.S.A.D. No. 75 Board Policy IJJ sets forth a procedure to be followed if a student, parent, staff member, or community member wishes to object to instructional materials. If a complaint is not resolved after speaking with the person providing the materials and/or the Principal, this form shall be used to initiate a formal review process. Please complete this form in its entirety and return it to the Principal of the school. A copy of this form will be sent to the Superintendent. If you require a translation of this document, or other assistance in filling it out, please contact the building Principal. If you are seeking to exempt your child from an instructional material or required instruction, please see Policy IMBB — Exemption From Required Instruction.

Your Name
Address
Phone Number
Email Address
How are you associated with the school district? ☐ Student          ☐ Parent/Guardian           ☐ Employee          ☐ Community Member
In submitting this request, do you represent yourself or an organization?   ☐ Myself          ☐ Organization: _________________________________________________
Title of Resource
Author/Producer
Publisher
Type of material:   ☐ Book                ☐ Magazine/Newspaper      ☐ Textbook       ☐ Application/Software   ☐ Webpage          ☐ Digital Resource              ☐ Movie   ☐ Other: _______________________________________________________________________________
Did you review (read/view/hear/use) all of the material? If not, what parts did you review? ☐ Yes, all of it            ☐ No, the parts described below
What brought this material to your attention?
Why do you object to this material?
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?
Are you aware of professional reviews/judgement of this material?
In its place, what material would you recommend?
What would you like the school to do about this material?           ☐ Do not assign it to students.           ☐ Withdraw it from the Learning Commons and/or instructional program.           ☐ Restrict use of the material by grade or location. (Please describe below.)           ☐ Other. (Please describe below.)
Have you read Policy IJJ – Instructional and Library-Media Materials Selection? ☐ Yes                ☐ No

_____________________________________________________            _______________________

Signature of Submitter                                                             Date 

FIRST REVIEW: April 25, 2013
SECOND REVIEW: May 9, 2013
AMENDED: June 25, 2026