IJND-E 

EXHIBIT

TECHNOLOGY  RESOURCES

FILM/VIDEO REQUEST FORM

Teacher ______________________________________   Date ___________________     

Title of film/video _______________________________________________________

Rating of film/video ____________     Date film/video to be shown ____________

Explanation of how this film/video relates to the specific lesson or unit taught:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

(This portion to be filled in by principal)

The principal has checked for the following:

Relevance     ____________

Age Appropriateness     ____________

Rating     ____________

Purpose     ____________          ____________
             (Lesson)               (Reward)

o Approved     o Denied   ________________________________     ____________
               Principal's Signature           Date