Educator Film Screening Request

**Please Complete this form, print, and fax to our Education Coordinator at (985) 641-5726**

Contact Information:

Name_____________________________

School____________________________

Grade Taught:______________________

I prefer to be contacted by:

*Phone:__________________________

Best Time to Call:_________________

*Email:__________________________

Film Requested for Screening:

1st Choice:________________________

2nd Choice:_______________________

3rd Choice:________________________