HCCSC Video Request Form

1
HCCSC (Swank) Movie Request Form
2
Requested School Year* This field is required.
Please Select
Please Select
2024-2025
2025-2026
2026-2027
2027-2028
3
Teacher Name* This field is required.
First Name
Last Name
4
Teacher Email* This field is required.
example@example.com
5
School/Location* This field is required.
Please Select
Please Select
Andrews
Crestview
Flint Springs
Horace Mann
Huntington North
Learning Center
Lincoln
Riverview
Roanoke
Salamonie
6
Principal Email
example@example.com
7
Assistant Principal Email
example@example.com
8
Name of Video* This field is required.
9
State Standard/ Educational Reason for Request* This field is required.
Huge
Large
Normal
Small
Ok
Ok
10
Are there any fees associated with your movie request?* This field is required.Is there a green dollar sign by the title of the movie?
YESNO
11
Approval ID
Should be Empty: