6:210-E1 Movie Pre-Approval Form

According to Board Policy 6:210, before showing a movie for educational purposes that was originally created for theatrical release, teachers must obtain pre-approval from the building principal. This form must be completed and submitted to the principal prior to the beginning of the term in which the movie will be used.

Teacher :	Grade/Department:
School:	Subject/Course:
Brief Description of Movie:
Direct Instructional Connection of Movie:
Plan for Student Engagement (attach any questions or graphic organizers):
Signed Approval of Department Chair (if applicable: ________________________________
Signed Approval of Principal or Designee: ________________________________________

Date Adopted: September 18, 2007