GEORGIA STUDENT MEDIA FESTIVAL
OFFICIAL ENTRY FORM 2011
(Please type or print the information below)
Production Title: ______
Purpose: ______
Name(s) of Producer(s): (list additional names on back)
______
Number of certificates needed: ______
Media Release Form included for each producer: __ Yes __ No
Was GALILEO used and cited as a resource for this project? __ Yes __No
PURPOSE OF PRODUCTION (Check one.)
___ Story ___ Documentary ___ Instructional
___ Entertainment ___ Informational ___ Persuasive/PSAs
(If applicable) Length of Production ______(Minutes) ______(Seconds)
**ONLY THE FIRST SEVEN (7) MINUTES OF ENTRY ARE JUDGED**
Teacher: ______
School: ______Phone: ______
Address: ______
City, Zip: ______
GRADE (of oldest student): (Check one) PRODUCED BY: (Check one)
___ K ___1 ___2 ___3 ___4 ___5 ___6 ___ Individual ___ Class
___ 7 ___8 ___9 ___10 ___11 ___12 ___ Group ___ Club
PRODUCTION TYPE
___ Animation ___ Sequential Stills (without audio)
___ Live Action ___ Sequential Stills (with audio)
___ Interactive Stills ___ Sequential Stills (K – 5 Class Project)
___ Web Site Project has Audio: YES NO
Indicate equipment, software, and plugins (including version) used for production of entry: ______
______
Copyright Information (check all that apply)
____ Copyrighted material follows Fair Use Guidelines
____ We are using copyrighted material and have included written permission
____ All material was created by students.
CERTIFICATION: (by student producer(s)) I certify that I am an amateur and have never made a production for profit. This production was made entirely without the aid of any professional producer. If copyrighted material or music was used, permission has been obtained. The source of any public domain material or music used has been identified. A copy of the permission statement or a copyright disclaimer has been submitted with the entry. I understand that if this documentation is not included the entry will be disqualified. I have read all the rules and agree to abide with them. GSMF and affiliates have the right to make a copy of the production.
Signature: ______
CERTIFICATION: (by teacher or administrator) I certify that to the best of my knowledge this production has been made by students without the aid of any professional assistance.
Signature: ______