2019 Film Fest Video Proposal
Please submit this form if your school is interested in presenting a video during the Film Fest Session.
Identifying Information
Person Submitting Proposal *
Your answer
Job Title *
Your answer
Email Address *
Your answer
School District *
Your answer
Building Name *
Your answer
Grade Levels Served *
RPDC Region *
MO SW-PBS Training Level *
Please select the MO SW-PBS training level that your building is currently participating in.
2017-2018 MO SW-PBS Recognition Status: *
Fidelity of Implementation Criteria
2017-2018 and 2018-2019 MO SW-PBS data submission and implementation data will be reviewed to ensure that building is an active participant with MO SW-PBS and implementing SW-PBS with fidelity. This verification includes:

1. 2017-2018 Self-Assessment Survey (SAS) Schoolwide, Non-classroom and Classroom sub scale scores of at least 60% (please review your Total Score report at www.pbisapps.org)
2. Completion of 2018-2019 School Safety Survey (SSS)
3. Submission of 2018-2019 quarterly data (Quarter 1 and Quarter 2)

Video Submission
Provide the URL address for submitted video(s). (Should your video(s) be selected for viewing at the Film Fest, it will be necessary that we are able to download the video in advance).
URL: *
Your answer
Video Information
Briefly describe your video in 1-2 sentences. *
Your answer
Feel free to share any additional information about how the video(s) was produced and is used in your school. *
Your answer
Electronic Signature
I have secured local permission from the student(s), teacher(s), and administrator(s) involved in the production of the submitted video(s) and have the authority to submit the video(s) to the Film Festival. The video may be used by MO SW-PBS for promotional purposes, at training, or on the website.
Type your full name in the space below. *
Your answer
Please note there is no registration fee reimbursement of any kind for participating in the Film Festival. We look forward to viewing your videos! If your video is selected, you will be notified on or before April 8, 2019. Thank you for your submission!
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