ALA OFFICE FOR INTELLECTUAL FREEDOM

CHALLENGE DATABASE FORM

ALA OIF Use Only

OIF Record No.: ________________________
Date of Report:__________________________
Filed by: _______________________________

1. CHALLENGED WORK

Title:_________________________________________________

Author/Performer(s):____________________________________ (last, first name)

Copyright/Issue Date:________________

Publisher/Producer:______________________________________

ALA OIF Use Only

Origin: ___ Submitted* ___
Published In NIF: ___
Yes--date: ______________________

Comments/Reference Files:_________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________

2. TYPE OF WORK

Print: ___ Book ___ Textbk ___ Mag. ___ Nwsppr. ___ Pamph.
___ Play ___ Student Publn.

Non-Print: ___ Artwork ___ Film ___ Photo ___ Sound Recording
___ Video ___CD-ROM

Other: ___ Collection ___ Exhibit ___ Performance ___ Speech
___On-Line Resources ___Other:

3. GROUNDS FOR CHALLENGE: (check all applicable)

Cultural: ___ Anti-Ethnic ___ Insensitivity ___ Racism ___ Sexism ___"Inaccurate" ___ OTHER: ________________________

Sexual: ___ Homosexuality ___ Nudity ___ Sex Education
___ Sexually Explicit

Values: ___ Anti-Family ___ Offensive Language
___ Political Viewpoint ___ Religious Viewpoint
___ Unsuited to Age Group

Social Issues: ___ Abortion ___ Drugs ___Occult/Satanism
___ Suicide ___ Violence

4. INITIATOR OF CHALLENGE:

___ Administrator ___ Bd Member ___ Clergy ___ Parent
___ Teacher ___ Patron ___Elected Official ___Government
___ Pressure Group ___ Religious Orgn. ___ Other Initiator

5. ORGANIZATIONS SUPPORTING CHALLENGE: ______________________________________________________ ______________________________________________________ ______________________________________________________

6. INSTITUTION BEING CHALLENGED:

Name________________________________________________ Address______________________________________________ City/State/Zip__________________________________________ Phone________________________________________________

7. TYPE OF INSTITUTION BEING CHALLENGED:

School-Related: ___ School or ___ School Library:
Grade Level Affected ____ to ____

Other Library: ___ Academic ___ Public ___ Prison ___ Special
___ College/University ___ Community Group ___ Museum/Gallery
___ Publisher ___ Student Group ___ Theater
___ Other: ________________________

8.CONTACT PERSON FOR INSTITUTION:

Name________________________________________________ Address______________________________________________ City/State/Zip__________________________________________ Phone________________________________________________ Fax__________________________________________________ Email________________________________________________

9. STATUS OF MATERIAL

___Unknown ___Material Retained ___Materials Removed ___Materials Stolen/Defaced

Feel free to attach news clippings or other supporting material. Return to:

Office for Intellectual Freedom
50 East Huron Street
Chicago, IL 60611

THANK YOU FOR YOUR ASSISTANCE

Copyright 1997 American Library Association