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Submission Form


Part 1 of 2

This form must be completed and submitted online. Please print five hard copies submitted with five DVD copies of your film. Deadline: June 6, 2011
Title of Film/Video
Producer(s)/director(s)
Contact Person
Street Address
Street Address 2
City
State
Zip code
Telephone
Email

Distributor
Distributor Contact
Street Address
Street Address 2
City
State
Zip code
Telephone
Email
Website(s) for film

Submitted by (if other than producer/director/distributor)
Contact Person
Address
Address 2
City
State
Zip code
Telephone
Email
Year Film Initiated
Year Film Completed
Production Budget
Outreach Budget
Please list all private, community, corporate grantmakers or donor networks contributing to the production or distribution of the film/video.
Funder(s)
Type/Amount of Funding
(e.g., R&D, production, pre- or post-production, distribution)
Funder Contact Person
Funder Telephone Number
Funder Email Address
 




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