REEL CANADA : Program Request

School Name*:

Location*:

Contact Name:*

Email:*

Phone:*

Number of students currently attending school*:

How many students would you like REEL CANADA to accommodate?

Does your school have an auditorium?* YesNo

Does your school have an cafetorium?* YesNo

Does your school have an gymnasium?* YesNo

If yes, can it be partitioned? YesNo

What other facilities does your school have that can accommodate 100 or more students?*

Does your school have an ACF license to screen films?* YesNo

If no, would your school be willing to purchase one? YesNo

Do you have the support of your administration (vice principal, principal) for bringing REEL CANADA to your school?* YesNo

Have you spoken to any other teachers about the possibility of bringing REEL CANADA to your school?* YesNo

If yes, how many teachers would be willing to participate in bringing REEL CANADA to your school?

The REEL CANADA program often gets covered by the media. Do you foresee any problems with this (student clearances, parental permission, etc)?* YesNo

Does your school have a high percentage of at-risk students?* YesNo

If yes, please explain:

Please tell us about why you would like to bring REEL CANADA to your school:*

REEL CANADA Program Request