Exhibit

E 1312.2

Community Relations

Complaints Concerning Instructional Materials

CITIZEN'S REQUEST FOR RECONSIDERATION OF INSTRUCTIONAL MATERIALS

Citizen's Name:__________________________________________________________

Citizen's Address:___________________________ Phone #___________________

Citizen Represents: Himself/Herself:_______________________

Organization or Group:_________________

TITLE:____________________________________________________________________

AUTHOR:___________________________________________________________________

PUBLISHER:________________________ DATE OF EDITION:_____________________

Request received by:_____________________________ Date:_______________

1. To what do you object and why? (Please be specific: cite pages, tape sequence, video frame, and words)

2. Did you read/view the entire selection?

3. What is your recommendation?

? Do not assign it to my child.

? Re-evaluate its use in instruction.

___________________________________________________

Signature of citizen

_________________________________________ ____________________________

Action taken: Date:

Exhibit PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT

version: December 11, 2000 Palos Verdes Estates, California