APPENDIX D : REQUEST FOR RECONSIDERATION OF MATERIALS FORM Title of Work: Author:
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Format (Book, periodical, DVD, etc.): ___.. _____________.____________ Publisher:
Address:
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Telephone:___________________ Email: - - - - - - - - - - - - - - - - Do you represent (check one) : Yourself ---An Organization (name) ----------------------------_____ Other Group (name) _________________________ 1. Have you read or viewed the entire work? - - - - - - If not, which parts did you read or view? _____________________________
2. To what in the work do you object? _____________________________ 1