Local Broadcast Content Submission from Independent Filmmakers

1. Name*

2. Does this show currently have national distribution on public TV?*

For example, NETA, APT or PBS - We do not accept programs with national distribution.

Yes No

3. Copyright Holder*

4. Main Contact regarding film*

If different than applicant name.

5. Entity Name*

6. Entity Address*

7. Email*

8. Phone Number*

9. Project Title*

10. Is this a Series?*

Yes No

11. Number of episodes.*

12. Does Licensor/Co-Producer fully own the Program?*

Yes No

13. Please explain.*

14. Length of Program*

15. Short Description*

16. Does this program have non-english language?*

If the program has Spanish language, we will require Spanish captions

Yes No

17. What language?*

18. Are Rights and Clearances cleared?*

Yes No

19. Music Rights Cleared?*

Yes No

20. E&O has been secured?*

Please be advised without E&O it is possible that your entry may be denied.

Yes No

21. Screening Link*

22. Production Status*

Fine cut Final

23. Closed Captioned?*

Yes No

24. List of Funders*

Please let us know if the program has underwriters or funders, right none, if none exist.

25. Funder contribution amount.*

Please enter the funder name followed by the amount contributed. Enter N/A for not applicable

26. List any content that may need special attention including language, nudity or violence.*

27. Are their any instances of AI in your program?*

Yes No

28. Please list examples of AI instances and timecodes.*

29. Comments for the Panel

Treatment / Media Asset Attachment*

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