Library Materials Comment Form

1

Type of Material:

Type of Material:

Book

Magazine

Video

Display

Other If other, type text here.

2

Author:

Author:

3

Title:

Title:

4

Additional Information:

Additional Information:

Publisher

Publication Date

Call No.

5

What brought this item to your attention? (i.e.: casual reading, printed review, publicity, etc.). If from a printed review, please give title and date of reviewing publication, if possible.

What brought this item to your attention? (i.e.: casual reading, printed review, publicity, etc.). If from a printed review, please give title and date of reviewing publication, if possible.

6

Have you read or reviewed the entire item?

Have you read or reviewed the entire item?

Yes

No

7

What concerns do you have about the item’s content? Please be specific, citing pages if possible.

What concerns do you have about the item’s content? Please be specific, citing pages if possible.

8

Your Name:

Your Name:

9

Phone Number:

Phone Number:

10

Address:

Address:

Street Address

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

11

Representing:

Representing:

Self	Organization Name If other, type text here.

Appropriate library staff will give careful consideration to the comments you provide, and will respond in writing to you as soon as possible.

For Staff Use Only

Date received:	Staff Initials:	Forwarded to:
Date completed:	Staff Initials:	Copies to Branch Manager, Director

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