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________________



Non-Discrimination Statement

Iron County School District is committed to a policy of equal employment opportunity and does not discriminate in the terms, conditions, or privileges of employment on account of race, age, color, sex, national origin, physical or mental disability, or religion or otherwise as may be prohibited by federal and state law.

School District Office

Hours 8 a.m. - 5 p.m. Mon.- Fri.
2077 W. Royal Hunte Dr.
Cedar City, Utah 84720
PH 435.586.2804  FAX 435.586.2815