Appendix B
APPEAL REQUEST FORM - DUCHESNE COUNTY SCHOOL DISTRICT To appeal the decision of a previous library materials review
Title of the book/material: Author: Name of person appealing the previous decision: Telephone: Address:
City: Zip: Email:
1) Name of the school where the book/material is housed:
2) What is your affiliation with the school?
3) Please provide a written statement setting forth your rationale to appeal the School Committee’s decision regarding the book/material (attach additional pages as needed).
Signature:
Date:
* Please deliver this form to the school principal or the district office.
Made with FlippingBook flipbook maker