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Policy IJJ-E-1

Request For Reconsideration Of Materials

This form is intended to initiate a formal review process if you have concerns after speaking with the person providing the materials in question. 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. 

Your Name: ________________________________________________________

Address: ___________________________________________________________

Phone: _____________________________________________________________

Email: ______________________________________________________________


How are you associated with the school district? (i.e., parent, community member, employee, student)?

  • Parent/Guardian

  • Student

  • Employee

  • Community Member

Where did you or your student encounter this material/resource? 

School: ______________________________________________________________

Grade: _______________________________________________________________


Materials Description 

Material 

  • Book 

  • Movie 

  • Magazine 

  • Digital Content 

  • Other _______________________________

If printed material, please provide the following information:

Title: ___________________________________________________________________

Author: _________________________________________________________________


If other material, please identify: 

Title: ____________________________________________________________________

Material Description: ____________________________________________________

Request for Reconsideration 

❏ I have read/viewed in full the material to which I object. 

❏ I have read the South Portland’s Instructional and Library Materials Selection policy (IJJ.) 

1. What is your objection to this material? 

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

2. What action would you recommend in regards to this material? 

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Please attach any relevant supporting documentation you would like the review committee to consider. 


Signature of Complainant _________________________________ Date _____________ 


If you require a translation of this document, please contact the building principal.


*Please excuse any formatting errors.