Instructional Materials Consideration Request Form

Instructional Materials Consideration Request

Please use this form to submit instructional materials to be considered for adoption by the Instructional Materials Review Committee as outlined in Board Policy 6161.1.

The Board of Trustees believes that instructional materials should be selected and evaluated with great care to effectively support the adopted courses of study and be aligned with the development and evaluation of the District’s curriculum and standards. Taken as a whole, District instructional materials should present a broad spectrum of knowledge and viewpoints, reflect the ethnic and cultural diversity of our society, enhance the use of multiple teaching strategies and technologies, and comply with current legal requirements.

The Board’s priority in the selection of instructional materials is to ensure that all students in grades K-12 are provided with instructional materials that are aligned to state content standards in the core curriculum areas of reading/language arts, mathematics, science, and history/social science.
Instructional Material Being Submitted for Consideration
Title *
Author*
Publisher*
Copyright Year*
ISBN
Instructional Material Format*

BookVideoOther
Upload an image of the cover of the recommended text here*

Cancelof
Use of Instructional Materials
School
School(s): Please select all that apply.

Aliso Niguel High SchoolAliso Viejo Middle SchoolArroyo Vista K-8Bathgate Elementary SchoolBernice Ayer Middle SchoolBridges Community Day SchoolCalifornia Preparatory AcademyCanyon Vista Elementary SchoolCapistrano Valley High SchoolCapistrano VirtualCastille Elementary SchoolChaparral Elementary SchoolClarence Lobo Elementary SchoolConcordia Elementary SchoolDana Hills High SchoolDel Obispo Elementary SchoolDon Juan Avila Elementary SchoolDon Juan Avila Middle SchoolEsencia PK-8Fred Newhart Middle SchoolGeorge White Elementary SchoolHankey K-8 AcademyHarold Ambuehl Elementary SchoolHidden Hills Elementary SchoolJohn S. Malcom Elementary SchoolKinoshita Elementary SchoolLadera Ranch Elementary SchoolLadera Ranch Middle SchoolLaguna Niguel Elementary SchoolLas Flores Elementary SchoolLas Flores Middle SchoolLas Palmas Elementary SchoolMarblehead Elementary SchoolMarco Fortster Middle SchoolMarian Bergeson Elementary SchoolMoulton Elementary SchoolNiguel Hills Middle SchoolOak Grove Elementary SchoolOso Grande Elementary SchoolPalisades Elementary SchoolPhillip Reilly Elementary SchoolR.H. Dana Elementary SchoolR.H. Dana ENFSan Clemente High SchoolSan Juan Elementary SchoolSan Juan Hills High SchoolShorecliffs Middle SchoolTesoro High SchoolTijeras Creek Elementary SchoolTruman Benedict Elementary SchoolUnion High SchoolViejo Elementary SchoolVista Del Mar Elementary SchoolVista Del Mar Middle SchoolWagon Wheel Elementary SchoolWood Canyon Elementary School
School(s): Please select all that apply.*
Intended Grade Level*
Title of Course or Subject*
Course or Subject Level*

InterventionGrade LevelAccelerated
What subject(s) will the instructional materials support?*

History/Social ScienctEnglish/Language ArtsEnglish Language DevelopmentMathematicsScienceWorld LanguagesVisual & Performing ArtsOther
Requested recommendation:*

PilotCoreSupplementary
Estimated Readability *
example: Lexile Level
Rationale for adoption*
In what way will this material improve or enhance instruction?
Evaluation of Instructional Materials

Review of Instructional Materials*

	Yes	No
Does this instructional material include material or language which might be considered controversial or questionable by any segment of the community?
Have you compared this instructional material with other appropriate materials?
Have you reviewed the materials being recommended for adoption in relation to applicable statutes and regulations as listed in Board Policy 6161.1 ?

Describe strategies that will be used to address material or language that might be considered controversial or questionable.*

Rating of Instructional Material (Check the appropriate column)*

	Rating	Comments
Subject coverage
Relevance to course of study
Organization of materials for effective learning
Material is clearly presented in a suitable and interesting style
Accuracy, up-to-date, qualified authorship
Treatment of controversial issues
Format and durability
Illustrations: Well designed and meaningful
Instructional aids: Suggested activities, bibliographies, etc.
Citizenship values

Submitting Individual
Name of Individual Submitting Materials*

First NameLast Name
Email of Individual Submitting Materials*
example@example.com
Role of Individual Submitting Instructional Materials*

TeacherAdministratorParent/GuardianStudentCommunity Member
Submitter Signature*

Clear
Should be Empty:

Instructional Materials Consideration Request

Instructional Material Being Submitted for Consideration

Use of Instructional Materials

Evaluation of Instructional Materials

Submitting Individual