Request for Reconsideratoin of Instructional Materials or Library Resources: KEC-E

Instructions:

1. Only parents or guardians of a student who is enrolled in the school for which the request is made may file a complaint.
2. The complaint must be submitted within the same school year that the incident or concern that is the subject of the complaint occurred. Any complaint filed outside of this timeline will not be considered.
3. Each complaint may address only one item. Any complaint addressing more than one item will be rejected.
4. All fields on the form must be completed in a full and meaningful manner. Incomplete, cursory, or duplicated forms will not be considered.
5. The district will follow the criteria and processes set forth in Policy KEC and its accompanying regulation, KEC-R. Please frame your responses in the context of this policy and regulation.

School in which the material is located or being used: ___________________________________________________

Name (please print): _____________________________________________________________________

Telephone: __________________
Email Address:_______________________________________________________

Physical Address:_______________________________________________________________

Mailing address (if different from above):________________________________________________________________

Please check the type of material in question:

[   ]  Book/ebook              [   ]  Video                   [   ]  Kit
[   ]  Magazine                 [   ]  Audio                   [   ]  Other ______________________
[   ]  Pamphlet                 [   ]  Software     

Title of Material: _____________________________________________________________________

Author/Distributor:  ______________________________________________________
Copyright Year: __________________________________

The following questions are to be answered after the complainant has read, viewed or listened to the material. If sufficient space is not provided, attach and sign additional sheets.

1.  Did you read, view, or listen to the material in its entirety?

2.  Where is the material being used?     [   ]   Classroom       [   ]  Library/Media Center

3.  If it is being used in a classroom, please provide the following information:

Grade: ________________  
Name of class or subject:_______________________________________

4.  Are students required to use the material?        [   ]  Yes         [   ]  No           [   ]  I don't know

5.  Has this material been assessed by professional reviewers or educators? If so, please provide the text of a review and the citation from an objective, professional review source.

6.  What within the material do you object? (Please be specific. Cite pages or location.)

7.  In what ways does the material fail to comply with the criteria in Policy KEC and KEC-R?

8.  What do you believe is the theme or purpose of this material?

9.  How do you believe students would be affected by this material?

10.  Would you recommend this material for a different age group?

11.  What other materials of the same subject and format would you recommend? Provide an objective, professional review source for your recommendation.

12.  What is your request in regard to this material?

[   ]  Do not assign it to students at this grade level       

[   ]  Withdraw it from use at the school

[   ]  Require parental permission for use                         

[   ]  Refer it to a review committee for evaluation

13.  Describe your efforts made to resolve the complaint at the appropriate school building level, including date of conference with the school principal.

Signature of complainant:                                                                                    Date:

Submit the completed form to the District 

via email to byork@sd27j.net 

or by U.S. Mail to:

Beth York

88 N. 40th Ave.

Brighton, CO 80601 

Forms submitted via other channels will not be accepted nor considered.

Revised June 10, 2026