2. Title*
4. Author*
6. Format*
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10. Telephone*
12. Address*
14. I Represent Myself*

    1. Yes
    2. No
16. If No, Name Organization or Group Represented
18. The individual completing this form must be a resident of Grayson County.
20. Please answer the following questions.
22. 1. Are you aware of the guidelines set out in the Library’s Collection Development Policy, which is available upon request?*
24. 2. Why do you think the library has placed this work in the collection?*
26. 3. (a) Have you read/viewed/listened to the entire work?
    (b) If not, which part/s have you read/viewed/listened to?*
28. 4. Please state your specific objection/s to this work.*
30. 5. (a) What do you feel might be the result of reading, viewing, or listening to this work?
    (b) For what age group would you recommend this work?*
32. 6. (a) If this work is fiction, what do you think is the theme?
    (b) If non-fiction, what do you think is the purpose of this work?*
34. 7. Is there anything in this work that any library users would find of use or value?*
36. 8. Are you aware of the judgment of this work by literary critics?*
38. 9. In its place, what work of equal literary quality would you recommend?*
40. 10. What would you like your library to do about this work?*

    1. Withdraw it from the collection
    2. Move it to another area
42. Name*
43. Date*
    Date
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