Request to Show Commercially Purchased Video/DVD

Policy Code: 
Adoption Date: 
Tuesday, January 27th, 2009

Request to Show Commercially Purchased Video/DVD

Teacher ___________________________________________Date________________


Video/DVD Title ____________________________________Rating ______________

(Please refer to: ICSD Policy IGDC – Video Recorded Media)



Date to be shown _________________ Class Period ____________________



Check one of the following viewing applications:


_____video/DVD shown in its entirety                  _____appropriate clip previewed

                                                                                        by the teacher named on this form


Subject Area ____________________________ Grade Level ______________



Provide a rationale that supports the connection between the content of the video/DVD and the instructional objectives in the Utah State Core Curriculum:








Department Chair__________________________________ Date________________



Administrator_____________________________________ Date________________