WELCOMEREGULATIONSVIDEOSORDERREPORTHOME
   
Your report will keep it free! Why this report is essential  
     
  This report must be filled in completely and submitted as part of your free showing.
Your compliance ensures the future of the Free Loan Video program!		  

 
Name:
Position:
School:
Address:
City:
State:     Zip
Phone:
Email:
Video Title:
Number of Showings:
Total Attendance:
   
  How was the film or video used: (Please list each showing)

Assembly
Showings:		 Grade: Est.
Attendance:
Classrooms: Grade: Est.
Attendance:
Classrooms: Grade: Est.
Attendance:
Classrooms: Grade: Est.
Attendance:
Classrooms: Grade: Est.
Attendance:
Other
(Specifiy):		 Grade: Est.
Attendance:

  Please give reactions to the film or video from:
   
Students:
Teachers:
 

 
 
 
This free service to secondary education is available only in the U.S. and Canada.
FreeMedia.org © Copyright 2000 GCI