This form would be submitted to the media specialist by a parent, student,
or community member for material that the person finds inappropriate. A sample of what the form
should include may be found at I would also suggest adding lines for
suggested actions (removal or restriction of material), and material that could be added to take the
place of material being reconsidered. The process for reconsideration must be addressed in your
AUP POLICY/CONTRACT � You will probably get this from your county as most counties have all
schools follow the same policy for acceptable use of computers/Internet. It is okay to copy this
form from a county website. However you must cite the source used to obtain the information.
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