The School Board of Gadsden County - SCHOOLinSITES

The School Board of Gadsden County

"Building A Brighter Future"

REGINALD C. JAMES SUPERINTENDENT OF SCHOOLS

Video Approval Request

35 MARTIN LUTHER KING, JR. BLVD QUINCY, FLORIDA 32351 TEL: (850) 627-9651 FAX: (850) 627-2760

Media materials acquired from any source (e.g. purchase, rental, loan, donation) shall be evaluated and recommended for use with students by appropriate staff of the school. Evaluations shall be based on personal review, professional judgment, or from information in professional library, media, or education selection aids or journals, if available. Careful consideration of materials which might be objectionable to the various mores of the school community will be made in the light of literary merit and the contribution to be made toward the education of the student.

Teacher's Name_______________________________________ Today's Date__________________

Video Title ___________________________________________________________________________

Date(s) to be shown___________________________________ Class Period(s)_________________

This video is from: School's Media Collection ______ Commercial Broadcast ______ Public Library______

Classroom Collection______ Public Broadcast______ Rental Store______

This Video is rated: Not Rated ______

G______

PG______

PG-13______ R______

I verify the following to be true: 1. This video was NOT recorded form a subscription (pay) channel or cable (this includes HBO, Disney, Showtime, etc.) 2. I have previewed this program and I find it suitable for classroom use. 3. The viewing of this video reflected in my lesson plans and is relevant to what is currently being taught in my class.

Describe how the video is an integral part of the lesson. ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

_____________________________ (Signature)

Approved__________ (Administration) Disapproved_________(Administration)

Date:_________________

ERIC F. HINSON DISTRICT NO. 1 HAVANA, FL 32333

JUDGE B. HELMS, JR. DISTRICT NO. 2

QUINCY, FL 32351

ISAAC SIMMONS, JR. DISTRICT NO. 3

CHATTAHOOCHEE, FL 32324 GREENSBORO, FL 32330

CHARLIE D. FROST DISTRICT NO. 4

GRETNA, FL 32332 QUINCY, FL 32352

BOARD MEETS FOURTH TUESDAY OF EACH MONTH

ROGER P. MILTON DISTRICT NO. 5

QUINCY, FL 32353

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