REQUEST FOR RECONSIDERATION FORM

WATERFORD PUBLIC LIBRARY REQUEST FOR RECONSIDERATION FORM 
 
The Waterford Public Library Board of Trustees has delegated the responsibility for selection and 
evaluation of library materials and resources to the library director and staff.  Waterford residents 
may request Library review of any item in the library’s collection, on display or any library program 
by completing this form and returning it to:   
Library Director, Waterford Public Library, 49 Rope Ferry Rd, Waterford, CT  06385 
 
Please include your full name, address, and telephone number on this form or it will not be 
accepted. All requests must be from a Waterford resident 
 
Please note the patron requesting reconsideration of library material will be given a packet of 
documents that includes the library’s Collection Development and Maintenance Policy, the First 
Amendment of the United States Constitution, the Library Bill of Rights, the Freedom to Read, and 
the Freedom to View statements from the American Library Association. These documents are 
available at the Library’s Information Desk and must be picked up in person. 
 
Name 
 
Date 
 
Address 
 
 
 
Phone 
Email Address 
 
  
  Do you have a Waterford Public Library card? □ Yes  □ No    
 
Do you represent yourself or an organization?  
 
If an organization, please provide its name, address and website 
___________________________________________________________________________ 
 
______________________________________________________________________________ 
______________________________________________________________________________ 
1. Resource on which you are commenting: 
 
Book   
Display   
Movie   
Magazine   
Library Program 
 
Music  
Newspaper  
Artwork  
Other (please specify)  
 
 
Title 
 
Author/Artist/Producer/Provider 
  
Format or Online Resource, if applicable ____________________________________________ 
For programs, please provide the program date_______________________________________ 
For displays, please provide the topic or theme_______________________________________ 

 
2. Specify which portion or portions of the material, display or program you find objectionable and 
explain the reason for your objection. If the item is a book or audiobook, please specify chapters 
and/or page numbers. (Use additional pages, if necessary.) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
3. What brought this resource, display or program to your attention? 
 
 
 
 
 
4. Have you read or viewed the material in its entirety? □ Yes  □ No   □ Not applicable 
 
 
 
 
 
5. What concerns you about this resource, display or program? If the item is a book or audiobook, 
please specify chapters and/or page numbers (Use additional pages, if necessary.) 
 
 
 
 
 
 
 
 
6. What do you believe is the purpose of this resource, display or program? 
 
 
 

 
 
7. In your opinion, for what age group should this resource, display or program be recommended? 
 
 
 
 
 
8. Overall, do you think this resource, display or program has any value? 
 
 
 
 
 
 
 
 
 
 
9. Are you aware of any critical reviews of this resource, display or program? Please list here, or 
provide as an attachment. 
 
 
 
 
 
 
 
 
 
 
10. Why do you feel your negative feelings about this resource, display or program should prevent 
access by other members of the Waterford community who may not share your concerns? 
 
 
 
 
 
 
 
 
 
 
 

 
11. What steps would you like the library to take to address your concerns? 
 
 
 
 
 
 
 
Please sign and date below and return this form to the Library Director. You will be notified 
within 60 days of receipt of the results of the reconsideration process. Reconsideration requests 
are not confidential patron records under section 11-25 of the Connecticut General Statutes. 
 
 
Signature 
  Date 
 
 
 
 
================================================================================= 
 
 
For Library Use Only: 
 
Date received: _________________   Received By Staff initials: 
__________ 
 
Reviewed by:  
 
__________________________________   ________________________  ___________________ 
 
 
(Name) 
 
 
 
 (Title)  
 
 
(Date) 
 
 
Board of Trustees – November 18, 2025