KET Staff Services

School:

District:

County:

Address:

City:

State:

Zip Code:

Teacher Contact:

Teacher Contact E-Mail:

Video Producer(s):

Web Site:

Phone:

MediaWorks Listserv
If you are not already receiving KET MediaWorks listserv e-mail messages about school video-multimedia production resources and methods, may we add your name to the list?

Yes
No

Type of Class, Group, or Individual Producing the Video:

School Video/Media Class
Other Subject-Area Class

Class or Group Name and Grade(s):

School Video/Media Club
Individual Student(s)
STLP Group

Title(s) and Description(s) of Video(s):

Use other side of page if needed.

Editing Software and PC or Editing System Used:

Our school gives KET permission to use this submitted media in KET-produced video, audio, or Internet projects, including Internet web pages and Internet video streaming. Signed participant and subject releases have been collected and are on file at the submitting school or board of education office.

Signature of School Principal or Authorized Representative:

________________________________________

Date:

____________

Printed Name:

________________________________________

Title:

________________________________________