Media application and project schedule
1.
Project Title
2.
Purpose of filming/videotaping/
photography
Mark as many as apply.
3.
[Production] Company / Organisation
4.
Co- production/on behalf of
5.
[Production] Company / Organisation
Contact Name & Address
6.
[Production] Company / Organisation
Invoice Name & Address
If different from 5.
7.
Description of what is to be filmed on the
Premises
Set out a brief description of the Scene or Scenes to be
filmed on the premises. If you have a specific location in
mind please specify, otherwise give us a rough idea of what
sort of location you are hoping to use, giving as much detail
as possible.
8.
Names of staff to be interviewed (if
applicable)
9.
Project Period
Date(s) and time(s) of filming.
10.
Details of film/videotape/ photography
Explanation of story/context in which the Premises will be
shown, where else is filming/videotaping/photography taking
place, who else is being interviewed
11.
Has the Project been commissioned?
12.
Intended broadcast date?
13.
Intended audience?
E.g. children/adults/specialist market
Last updated by the Communications Unit on 17/07/2016
14.
Names of crew
15.
Names of cast (if applicable)
16.
Names of other people involved in the
Project
17.
Name and Number of senior person from
organisation on site
18.
Equipment to be brought onto the
Premises
If not available, must be provided at least 48 hours before
filming /shoot
Specify quantity, type and weight of cameras, lights, sound
equipment and other equipment together with detail as to
whether each is battery or mains powered and the applicable
ratings (in watts)
19.
Specify any other on site requirements
Temporary power supplies etc.
20.
Props to be brought onto the Premises
This document is a request to film or take photographs on Trust premises. It does not constitute a filming or
location contract nor does it imply permission to film/photograph. A separate contract may be drawn up if
permission is granted for this project to go ahead. Please note we do not normally provide parking facilities
or props.
Please return a copy of this form to the Communications Unit, preferably by email.
Contact details
Communications Unit, Trust Headquarters, Second Floor Central, 250 Euston Road, London NW1 2PG. Tel
020 7380 9897, Fax 020 7380 9401, Email media.enquiries@uclh.nhs.uk
Last updated by the Communications Unit on 17/07/2016