Media Project Request Form Page 2
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3Other groups/people being interviewed for the project
1. __________________________________
2. __________________________________
3. __________________________________
4. __________________________________
Location
Institution - Please specify: ____________________________________________
Regional Headquarters - Please specify: __________________________________
Community Correctional Centre - Please specify: ___________________________
National Headquarters
Other _______________________________________________________
Indicate whether your intended use is
Commercial
Non-commercial
Indicate the anticipated uses of the project
TV Documentary
Other filming or TV requests
DVD
Web/social media
Radio
Newspaper
Magazine
Book
Others, please specify: _____________________________________
Describe the audience for your proposed use
General
Children
Youths
Adults
Senior Citizens
Others, please specify: _____________________________________
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