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*
Email Address*
example@example.com
Name of Request*
Type of Request*

VideoAudioPhoto
Is your request a Live Recording or Media Production?*

Live RecordingMedia 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*

InterviewsLecturePublic AddressWorkshopAwards CeremonyOther
Length of Event or Production*
Hours
Is this production part of a series?*

YesNo
Script*

Browse Files
Upload your script Cancelof
Delivery Format*

Digital CopyYouTubeYouTube - Live StreamOther
Do you have permission to use materials that will appear in the video?*

YesNo
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?*

YesNo
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*

I understand that it is my responsibility to have a consent form signed by all participants involved in the production
Download Consent Form
Additional Information/Comments
Should be Empty: