Form Citizen Objection Curriculum Instructional Material: KEC-E

Citizen’s Objection to Instructional Materials, Methods, Curriculum, or Activities

1. Child’s Name_______________________________________

2. Parent’s Name ______________________________________

3. Address______________________________ Zip __________

4. Telephone _________________________________________

5. School/Teacher(s) Involved ____________________________

7. Class or Subject ____________________________________

8. What are the specifics of your objection?

a. If you are challenging instructional material, please complete the following:

Title of Material: _______________________________________

Author or Publisher: ___________________________________

Pages or incidents to which you object: ____________________
____________________________________________________________________________________________________________________________________________________________

b. If this is an activity or instructional method, give examples of each incident related directly to each objection. ____________________________________________________________________________________________________________________________________________________________

9. How do you perceive this instructional material or situation impacting your child? ____________________________________________________________________________________________________________________________________________________________

10. What are the positive aspects of this situation? ____________________________________________________________________________________________________________________________________________________________

11. Would this material/activity be suitable for a different age group? ____________________________________________________________________________________________________________________________________________________________

12. Are you aware of any research and/or professional review of the instruction material, curriculum, method, or activity? ____________________________________________________________________________________________________________________________________________________________

13. What specific relief are you requesting? ____________________________________________________________________________________________________________________________________________________________

14. Please list any other information that will help us understand and/or resolve this concern. ____________________________________________________________________________________________________________________________________________________________