MOVIE REQUEST
NAME OF MOVIE_______________________________________________________
RATING____________________
LENGTH_______________________
TEACHER__________________________________
SUBJECT TAUGHT________________________
Briefly describe how this movie will correlate with the curriculum of your class____________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Approved by building Administrator_______________________________________________________
Date________________________
ALL MOVIES MUST ADHERE TO THE FOLLOWING SCHOOL BOARD POLICY:
GENERAL GUIDELINES
1.
2.
3.
4.
Videos rated X, R, or NC-17 will not be shown.
Videos rated PG-13 will be shown only with written parental authorization.
Videos must be previewed and carefully screened for inappropriate language and violence.
Content of the videos must be appropriate for the age and interest level and must relate to the
total instructional program.
5. Teacher must take responsibility for showing videos to students.
6. Video log must be completed. The log will include video title, date shown, rating, class viewing,
and a statement of how the video correlates with the curriculum.
7. Videos used as incentives must be approved by the principal.
This does not apply to instructional videos found in our Library.
Copy of this request form will be kept in main office if movie is shown.