AUTHOR:  _________________________________________________


     TITLE: ____________________________________________________


     FORMAT: __________________ PUBLISHER: ___________________


     PUBLICATION DATE: _______________


   Request initiated by: ____________________________________________


   Address: ___________________________________ City: ______________


   Zip Code: ________________       Phone: __________________________


   Is this request made on behalf of?


   _____ Yourself


   _____ Relative ___________________________________________

   [Relationship to]

   _____ Organization ________________________________________    [Name of Organization]


   Have you read/ viewed this title in its entirety? __________


   What is your objection to the resource? [Please be specific; i.e. cite pages.]




Is there anything positive about the resource? _________________________________________


Please state the reason for your request ______________________________________________




Action Requested: ______________________________________________________________




Have you read the Effingham Community Library Resources Selection Policy? _________________


Page 1

Are you aware of the judgment of this resource by literary critics or area subject specialist? [Please provide names of reviewers and citations for reviews, if known.]


Can you recommend resourced of comparable literary quality or another title that would convey the same perspective of the subject treated? _______________________________________________


Date: __________________ Signature of Patron: ______________________________________


Date: __________________ Received by Staff Member: ________________________________


Decision of Director:


Keep book on shelf___


Remove book from shelf____


Move book to another part of the library___


If you do not agree with this decision you may request that the Library Board takes a look at the book.  Their decision will be final.



Please be aware that no book shall be removed from the shelves until a decision has been made.


Effingham Community Library.  Collection Development and Resource Access Plan for the Effingham Community Library:

June 2014




We have accepted the following number of titles at the Effingham Community Library:


Value asked by the Donor:




Name of Person receiving:




Library Stamp


Material donated to the Effingham Community Library will become property of the library to be used or sold as the library sees fit.