Off-Air Taping/Video Duplication Request Form

Verification of request will be emailed to you.

Requestor
Date Submitted (mm/dd/yyyy)
School Building
Phone Number
Email	Confirmation of request receipt will be email to this address.
Off-Air Taping
Off-Air Program Title
Channel
Air Date(s) (mm/dd/yyyy)
Time Aired
Length
Is the program part of a series? (i.e., Assignment: The World, Reading Rainbow)	Yes   No
If Yes:
How many programs are to be taped?
Are all air dates for each  program listed above?	Yes  No - If no, list additions dates below.
Additional dates (mm/dd/yyyy)
Do you want tape returned after each program?	Yes  No
If yes, is the correct number of tapes accompanying this form?	Yes  No
If no, all programs will be taped and returned after series is completed.
Video Duplication
Video Duplication Title
Length
Date Wanted (mm/dd/yyyy)
Comments