UCTV Program Contributors

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UCTV Program Submission Form

(Required fields are noted with an *.)

UCTV Program Submission Form

First Name *

Last Name *

E-mail Address *

Telephone *

Program Title

Series Title

Campus/Institution

Record Date

Category

Total Running Time
Minutes Seconds

Time Code
(tc start) (tc end)

Description (Short Paragraph)

Speaker Information

First Speaker: Last Name First Speaker: Affiliation Second Speaker: First Name Second Speaker: Last Name Second Speaker: Affiliation Third Speaker: First Name Third Speaker: Last Name

	First Name	Last Name
1.	First Speaker: First Name	First Speaker: Title
2.	Second Speaker: Title
3.	Third Speaker: Title	Third Speaker: Affiliation

Release Forms

Do you have signed release forms?

Yes, I have signed release forms from ALL participants.
No, I do not have signed release forms from ALL participants.

Viewer Contact Information

Viewers will receive this information when requesting more information about the program.

First Name
Last Name
Telephone
Web Site

Sending Videos

How will you deliver the media files?

Mailing DVD(s)
Mailing Video Tape(s)
Uploading digital file via FTP

Tape Purchase Information

May UCTV provide online access to your program?

Yes
No May viewers purchase copies of your program?

UCTV may sell copies of this program.
UCTV MAY NOT sell copies of this program.
WE WILL SELL copies of our programs. (If selling your own copies, viewers will be referred to the "Viewer Contact Information" listed above.)

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