Movie Approval Request Form
Instructions:
1. Complete this form
2. Rich Nichols will forward this information to your building principal via email
3. If your building principal approves the showing of this movie, forward the completed and approved form to Mr. Cook (Steve.Cook@perry.k12.ia.us) and Mr. Lipovac (Tom.Lipovac@perry.k12.ia.us).
4. You and your building principal will receive a confirmation e-mail from both Mr. Lipovac and Mr. Cook that your request has been received and the Performing Arts Center has been reserved for your requested times.
Teacher *
Your name (First and Last)
Grade *
What grade level do you teach?
E-mail address *
Enter your E-mail address
Today's date *
Movie Showing Date *
Date that you want to show the movie in the PPAC
Movie Showing Time *
What time of the day do you want to reserve the PPAC
Name of Movie *
What is the name of the movie you would like to show?
Movie Details
Please describe how this movie ties to your curriculum and course syllabus. This information is the key to allowing an exemption to federal copyright laws concerning the public showing of copyrighted works.
*
Submit
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