Media Services Production Request

Media Services Production Request
Contact Person

First NameLast Name
Organization/Department Name
Organization Address/Department Location

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Name of Request
Type of Request
Is your request a Live Recording or Media Production?
Please select Live Recording if you are looking to capture a Live Event or Class that is scheduled at a specific date and time. Select Media Production if you are looking to create a Pre-Scripted Promotional or Instructional audio or video recording.
Location of Live Event

Street Address

Street Address Line 2

CityState

Zip Code
Date of Live Event

MonthDayYear
Date
Time of Live Event

:HourMinutesAM/PM Option
Date Production Needs to be Completed

MonthDayYear
Date
Type of Live Event

Other
Length of Event or Production
Hours
Is this production part of a series?
Script

Browse Files
Upload your script Cancelof
Delivery Format

Other
Do you have permission to use materials that will appear in the video?
Materials may include a written script, photographs, video clips, music, etc.
Do you have permission to record the people who will be featured in your video?
Video participants (e.g. event speakers, interviewees, etc.) must provide their consent to be filmed and fill out a Middlesex College consent and release form.
Consent Agreement
Download Consent Form
Additional Information/Comments
Should be Empty: