Please fill out completely and return to Director Steven Cook
Name of complainant
State Zip code
Starr Library card number
Are you making this challenge as an individual ? (check here if yes)
Or as the representative of an organization? (check here if yes)
If you are speaking on behalf of an organization, give the name and address of the organization:
Type of item you are challenging (fill out a separate form for each item challenged):
- Computer program
Title of item
Date of publication
What brought this item to your attention?
Is your objection to this item based upon your own exposure and reaction to it, upon complaints about it made directly to you by others, or upon reports you have heard about?
Have you read, viewed, or listened to this item in its entirety? If not, what portions of it have you read, viewed, or listened to? (List portions by page number, time into tape, or other identification.)
To what specific aspects of the item do you object? Cite specific pages, passages, or scenes. Can you suggest any materials to provide additional information or other viewpoints on this topic? (Use back of page and additional page, if necessary.)