Request for Video Approval


Teacher Name:


Grade Level:


Title of Video:



Video Rating:


Date and Time of Airing:


Objectives Covered:










Follow-up Activities:










Evaluation of Activities/Students:










As part of the video approval team, please view the accompanying video in its entirety.After viewing the video, please fill out the appropriate portion below stating whether or not you feel the video will fulfill the needs as stated on the previous page.After completing your portion, please send the video and form to the next person on the list.

Requesting Teacherís Review


Principalís Review:


Media Specialistís Review:


Community Memberís Review: