Union City Community Schools

Video Use Form

*Must Be Completed For Each Video Shown!*

Please complete and submit prior to showing a video.

Building: Elementary School Middle School High School

Requesting Teacher:

Video Title: Rating:
Video Source: Length to be Shown:
Class/Subject it will be used in: Date to be used:

State Benchmark(s) to be Targeted:

Describe how the video/clip will be used to teach the Benchmark(s):