Request to Distribute Materials Form

Huntington County Community Schools Corporation

Request To Distribute Materials in Schools

*HCCSC does not use email for the distribution requests.

Please complete the form and submit it, along with an attached sample copy of the item you wish to distribute at least two weeks prior your requested distribution date.

Approval does not mean that the school corportation:

1. supports, recommends or advocates for the materials or program,

2. requires teachers or students accept the materials or take part in the program,

3. is responsible for the materials and its content,

4. is responsible or liable for any claims resulting from the participation of any employee or student in the program or distribution of materials.
Name of the Organization*
Contact Person- Name*

First NameLast Name
Contact- Email*
example@example.com
Contact- Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact- Daytime Phone Number*
Please enter a valid phone number.
Type of materials to be distributed: (brief discription)*
File Upload - Please attach a sample copy*

Cancelof
Requested Date of Distribution*

MonthDayYear
Date
Distribution options:

Paper flyer to every school and every grade levelPaper flyer to selected school(s) and selected grade level(s)Flyer available to be picked up in the front officeSchool announcement pertaining to your documentDisplayed throughout school buildings
Requested School(s)*

Andrews ElementaryCrestview Middle SchoolFlint Springs ElementaryHorace Mann ElementaryHuntington North High SchoolLincoln ElementaryRiverview Middle SchoolRoanoke ElementarySalalmonie Elementary
Administrator -Email
example@example.com
Secretary -Email
example@example.com
Elementary Requested Grade Level(s)*

PKK1st2nd3rd4th5th
Middle School Requested Grade Level(s)

6th7th8th
High School Requested Grade Level(s)

9th10th11th12th
Reason for distribution: (please leave a brief discription)*
Reason schools system was chosen for distribution:*
Contact Person - Signature (by signing this application, you understand and agree to the aforementioned terms)*

Clear
Today's Date*

MonthDayYear
Date
Office Use Only

ApprovedDenied
HCCSC Sponsored - Signature

Clear
Reason for Denial

Policy 9700Other
Reason for Denial-Text
Superintendent Signature

Clear
Today's Date

MonthDayYear
Date
Should be Empty: