For access to the form, click here.
Policy IJJ-E-1
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.
