Intellectual Freedom
ALA Office for Intellectual Freedom
Censorship 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
*PLEASE
NOTE: THIS INFORMATION IS FOR STATISTICAL USE ONLY. NAMES OF
INDIVIDUALS AND INSTITUTIONS WILL BE KEPT CONFIDENTIAL.
Feel free to attach news clippings or other supporting material.
Return to:
Office for Intellectual Freedom
50 East Huron Street
Chicago, IL 60611
FEEL FREE TO COPY AND DISTRIBUTE FORM
THANK YOU FOR YOUR ASSISTANCE |
