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To be completed by School Administration 1. Has this request been resolved as per 4.0540.04.M of the DCSD Library Materials
Policy or does it need to move to a Review Committee? 2. Is the Requestor above making the request due to: a) A claim of a sensitive materials infringement or
b) A claim of an age-appropriateness infringement What brings you to this conclusion? What brings you to this conclusion?
School Administrator’s Signature: _____________________________________ Date: __________________
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