Filming Request Form This form is intended for students in the department of Film, Video, Animation & New Genres wanting to request permission to film in a UWM Building. Filming requests must be submitted at least two weeks prior to your proposed filming date. Name(Required) First Last UWM Email(Required) Phone(Required)Project/Class Associated with this RequestProject/Class Instructor NameProject/Class Instructor Email(Required) Dates & Details It is not always possible to honor the first date choice, please enter two potential filming dates. 1st Choice Date Requested MM slash DD slash YYYY 1st Choice Start Time Hours : Minutes AM PM AM/PM 1st Choice End Time Hours : Minutes AM PM AM/PM 2nd Choice Date Requested MM slash DD slash YYYY 2nd Choice Start Time Hours : Minutes AM PM AM/PM 2nd Choice End Time Hours : Minutes AM PM AM/PM Provide a description of your proposed film shoot while being as specific as possible.Location InformationBuildingRoom Number Policy Agreement The User agrees to comply with all applicable laws, regulations, and policies of the University of Wisconsin System, the University of Wisconsin-Milwaukee, and Peck, including any policies pertaining specifically to the use of the Facilities. These include, but are not limited to, the following: Wisconsin Administrative Code Chapter UWS 18: Conduct on University Lands UWM Policy 3-1: Alcoholic Beverages, Guidelines for Service UWM Policy 6-5: Use of Facilities Policies and Procedures UW System Administrative Policy 625 Consent(Required) I acknowledge and agree to abide by the policies listed above.Condition of space upon completion of filming(Required) Please acknowledge that you will leave the space in as good a condition as it was when you began your install/filming.Acknowledgement of Restricted Materials(Required) Please acknowledge the following: If affixing to a wall you must use blue painters tape or an approved fastener (check with psoahm@uwm.edu for approved fasteners). No fog, haze, glitter or pyrotechnics are allowed in PSOA spaces without the express written permission of the PSOA Facilities Director.Acknowledgement of Consent Requirements(Required) No UWM student shall be filmed without their express consentConsent2(Required) Requester and its personnel shall not share identities of, or any information learned from or about, UWM students during the User’s use of the Facilities without such students’ express consent.(Required)Consent2(Required) Both Requester and UWM acknowledge and agree that UWM’s approval of the requested use does not constitute endorsement by UWM or the State of Wisconsin of the views, objectives, philosophy or ideology expressed or otherwise propounded by the User(Required)E-Signature Agreement(Required)By selecting the “I agree” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting “I agree” using any device, means, or action, I consent to the legally binding terms and conditions of this document. I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. I agree