Objection to Instructional Materials Form

	It is expected that the material in question has been read, viewed, or listened to in its entirety.

1.	Please check the type of Instructional Materials:*
	Textbook    Audio-Visual (Video, CD, etc.)    Other, please specify

2.	Title:

3.	Author:

4.	Publisher or Producer:

5.	Student Name:

6.	Schools:*

7.	Objection initiated by:*
	Objection initiated by:* Parent / Guardian Community Member

8.	Telephone (Home):*

9.	Email:*

10.	Address:*

11.	City:*

12.	State:*

13.	Zip:*

	It is expected that the material in question has been read, viewed, or listened to in its entirety.

14.	Please identify the Instructional Materials (whether the entire text or the pages, or chapters within) to which you object*

15.	Is your objection(s) based on a review of the entire material”? *
	Is your objection(s) based on a review of the entire material”? * Yes No If not, what parts did you not examine?

16.	What content within the material you reviewed did you find not appropriate for Instructional Materials purposes? (Please be specific, Cite pages, film sequence, etc.)*

	Please refer to Board Policy 2520 regarding the Instructional Materials Objection process.