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Video Production Request

Please complete this form to request our video production services. Requests should be submitted no later than 2 - 3 weeks prior to the production date. By completing this form, the requestor agrees to the copyright rules applicable to the production. If you experience any difficulty with the application form, please contact us.

Contact Name:


Phone number:


Mailing Address:

Billing Contact Information

Production Information

Requested Production Date:

Production Title (if known):

Production Location:

Event Time (if live event):

Purpose of Video: What do you want the video to achieve?

Target Audience:

Where will the program be seen? (Broadcast Television, DVD, Web, etc):

More Details/Project Description

Budget Allocated (if known): $

Production Elements

Please check any/all elements you would like to include in your program.
*By including any of these elements, you are agreeing to obtain any necessary copyright clearance and Academic Technologies is not held accountable for infringement of the rules and regulations held to the University system.

Logistics & Equipment Requirements
Please check any/all equipment requirements for your production.

*Select "Not Sure" if you are unsure of your production requirements. We can suggest the appropriate amount needed based on the information provided by this request.

(ex: CD audio playback during an event dinner, etc.)