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File: KEC-E

Washington County Public Schools


10435 Downsville Pike
Hagerstown, Maryland 21740

Request for Consideration of Instructional Resource

Complainants Name __________________________________________________________________

Mailing Address ______________________________________________________________________

Email Address _____________________________________ Phone __________________________

Title of Instructional Resource ___________________________________________________________

Author ______________________________ Type of Resource ______________________________

Publisher or Producer (if known) _________________________________________________________

Name of school where this resource is in use _______________________________________________

1. What are your objections to the instructional resource? (Please cite concerns.) ________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

2. What is your proposed remedy? ______________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

___________________________ ______________________________________
Date Signature

Return completed form to:


Chief Academic Officer, Washington County Public Schools, 10435 Downvsville Pike, Hagerstown, MD 21740

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