Please read related policy

1) Name ____________________________________ 2) School/College___________________________
3) Department/Organization ______________________________________________________________
4) Phone (day) ________________________  5) HU I.D. No.____________________________________
6) Please check the box that applies:
         [  ] FACULTY        [  ] STUDENT        [  ] STAFF        [  ] OTHER (specify) _____________________
7) Course Number/Name _________________________________________________________________
8) Faculty Advisor for Project _____________________________________________________________
9) Date(s) filming will take place _________________________ 10) Time (from) (until) ______________
11) Library areas or department(s) involved _________________________________________________
12) Purpose of photography/filming (course work, thesis project, news story, professional production,
promotional material, etc): _______________________________________________________________
______________________________________________________________________________________
13) Production equipment being used, including lighting: _______________________________________ ______________________________________________________________________________________
14) Names of persons involved, actors and crew: _____________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
15) If dialog, music or other sound effects will be used, describe:
______________________________________________________________________________________ 

NOTE: Please keep in mind that library staff are working and may not want to be
photographed/filmed at all.

  By signing this Request, I hereby:

(a) acknowledge that the law may require me to receive the consent of every person photographed/videotaped/filmed and that failure to receive such consent may result in litigation against me. I understand that I am solely responsible for acquiring the written consent of each person photographed/videotaped/filmed;
(b) acknowledge that I am solely responsible for the content of the photographs/videotapes/films and how they are used;
(c) agree that I am not using the photographs/videotapes/films for any commercial or news media purposes, without appropriate authorization; and
(d) acknowledge that I have received and read a copy of the Guidelines for Photography, Videotaping, and Filming in the Howard University Libraries, and agree to follow these guidelines and procedures.

  Signature date: ______________________________________

  For Library Use:    [  ] Approved           [  ] Not Approved

  Authorized by (signature) _____________________________________ Date ___________________

  Comments: