Video Production Application
You need to file this form if you (1) plan to film on public or private property that is not a part of Mansfield University AND/OR (2) plan to use weapons of any kind (knives, clubs, firearms, etc.—whether they are real or fake), and/or film scenes involving fighting, blood effect, loud noises or yelling, or any other elements that may cause an unsuspecting observer/passerby to become alarmed.
General Information
First Name
The name of the person filling out this form.
Your answer
Last Name
The name of this person filling out this form.
Your answer
Email address:
Your answer
Phone number:
This is the phone number where you can be reached.
Your answer
Type of production:
Required
This production is related to:
Please explain the reason for this production (class assignment, personal production, MU60, etc).
Your answer
Faculty Coordinator/Supervisor
The name of the faculty who is advising the project/teaching the course.
Required
Course Name/Number
If applicable, the course name or number that is associated with the assignment.
Your answer
Student Club/Organization (list club name):
If applicable, the name of the club/organization.
Proposed date(s) of shoot:
Your answer
Proposed time(s) of shoot:
Your answer
Location(s) of shoot (include specific room numbers, hallways and/or outdoor locations):
Your answer
Description of the production:
Your answer
Proposed number of film crew members involved in shoot:
Your answer
Proposed number of actors & extras involved in shoot:
Your answer
Will the proposed production involve any of the following (check all that apply):
Required
By checking the box below I certify that I will follow all procedures of getting written notification and/or notifying campus and boro police and homeowners.
Required
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