J.C. Clegg Public Library 137 4th St. North Central City, IA 52214 Date______________________ Title____________________________________________________________________ Book__________ Periodical__________ Other___________ Author__________________________________________________________________ Publisher________________________________________________________________ Request initiated by________________________________________________________ Address_________________________________________________________________ City________________________________State___________Zip__________________ Telephone_______________________________________________________________ Do you represent: 1. Yourself_____________________________________________________ 2. An Organization (name)________________________________________ 3. Other group (name)____________________________________________ 1. To what in the work do you object? (Please cite specific pages) 2. Did you read the entire work?__________ If not, what parts did you read? _____________________________________________________________________ 3. What do you feel might be the result of reading this work? 4. What do you believe is the theme of this work? 5. Are you aware of the judgments of this work by critics? 6. What would you like your library to do about this material? Do not lend it to my child. __________________ Return it to the Board of Trustees for reevaluation._____________________ 7. Are you usually able to find what you want in the library? ___________ If not, what materials would you like to be able to find in the Library collection? Signature ____________________________________
