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.