Media Project Request Form (Page 3 of 3) in pdf

Media Project Request Form Page 3

Broadcast Region

Local

Provincial

National

International

Indicate the scheduled air date or issue date

______/_____/____

Date to be determined

YYYY MM

List the equipment required for filming:

1. ___________________________________

2. ___________________________________

3. ___________________________________

4. ___________________________________

5. ___________________________________

Indicate what are the benefits / what is the value of participating in this project:

For the requester:

1. __________________________________

2. __________________________________

3. __________________________________

4. __________________________________

For CSC:

1. __________________________________

2. __________________________________

3. __________________________________

4. __________________________________

DISCLAIMER

While efforts will be made by CSC to accommodate the filming/project request, all

requests are subject to assessment in accordance with the Commissioner’s Directive 022

and at any time if condition cannot be met under CD 022, or if the terms of admission are

not respected which could lead to security and operational concerns, access to the

institution could be refused/revoked/rescheduled.

Submission of this form is not to be considered as permission to present yourself to any

of our institutions or facilities for scouting or pre filming purposes. Until you have been

given formal approval that your project has been approved, there should be no attempts to

access any facilities or land under the responsibility of the Correctional Service of

Canada.

Media Project Request Form Page 3