Cobb County School District Form IFBC-3 Empowering Dreams for the Future INSTRUCTIONAL MATERIALS APPEAL FORM Adapted from the National Council of Teacher of English for Reconsideration of “Request Instructional Materials” Author Print Non-print Title Publisher (if known) Request initiated by Address Street City State Zip □ □ Opinions represent: Self Other 1. To what in the material do you object? (Please be specific; cite sections or pages) 2. What do you feel might be the result of reading/viewing/listening to this material? 3. For what age group would you recommend this material? □ □ 4. Did you read/view/listen to the entire material? No Yes What parts? 5. What did you find acceptable about this material? 6. Are you aware of the judgment of this material by qualified critics or review sources? □ □ No Yes If yes, please give citation 7. What do you believe to be the theme of this material? 8. What would you like your school to do about this material? □ □ Do not assign it to my child Place material at another school level □ □ Withdraw it from all students Other 9. In its place, what material of equal quality would you recommend? Signature Date 12/14/06
Cobb County School District Form IFBC-3 Empowering Dreams for the Future INSTRUCTIONAL MATERIALS APPEAL FORM Adapted from the National Council of Teacher of English “Request for Reconsideration of Instructional Materials” Author Print Non-print Title Publisher (if known) Request initiated by Address Street City State Zip Opinions represent: □ Self □ Other 1. To what in the material do you object? (Please be specific; cite sections or pages) 2. What do you feel might be the result of reading/viewing/listening to this material? 3. For what age group would you recommend this material? 4. Did you read/view/listen to the entire material? □ No □ Yes What parts? 5. What did you find acceptable about this material? 6. Are you aware of the judgment of this material by qualified critics or review sources? □ No □ Yes If yes, please give citation 7. What do you believe to be the theme of this material? 8. What would you like your school to do about this material? □ Do not assign it to my child □ Place material at another school level □ Withdraw it from all students □ Other 9. In its place, what material of equal quality would you recommend? Signature Date 12/14/06