Appendix L. North Carolina Challenged Work
Title:
_____________________________________________________________________
Author/Performer:
__________________________________________________________
(last, first name)
Copyright/Issue Date:
_______________________________________________________________
Publisher/Producer:
_________________________________________________________________
Type of Work
Print: ___Book ___Textbk ___Mag. ___Newsppr. ___Pamph. ___Play ___Student Publ.
Non-Print: ___Artwork ___Film ___Photo ___Sound Recording ___Video ___CD-ROM
Other: ___Collection ___Exhibit ___Performance __Speech __On-Line Resource ___Other
Grounds for Challenge: (check all applicable)
Cultural: ___Anti-Ethnic ___Insensitivity ___Racism __Sexism ___”Inaccurate” ___Other:
(explain) ____________________________________________________________________________
Sexual: ___Homosexuality ___Nudity ___Sex Education ___Sexuality Explict
Values: ___Anti-Family ___Offensive Language ___Political Viewpoint ___Religious viewpoint
___Unsuited to Age Group
Social Issues: ___Abortion __Drugs __Occult/Satanism ___Suicide ___Violence
Initiator of Challenge: _______________________________________________________________
Organization supporting challenge:___________________________________________________
Contact person for institution being challenged: (name, address, phone, fax, e-mail)
_____________________________________________________________________Type of Institution/library being challenged:___________________________________________
Status of material: ___Unknown ___Material Retained ____Material Removed ___Material Stolen/Defaced
Send to: Intellectual Freedom Committee, NCLA, 1811 Capital Blvd., Raleigh, NC 27604-2144.
