VACAVILLE UNIFIED SCHOOL DISTRICT
VACAVILLE UNIFIED SCHOOL DISTRICT
ON LINE AUDIO/VISUAL APPLICATION FOR INSTRUCTIONAL MATERIALS APPROVAL
TITLE AUTHOR
Highlight One: Video Disk, Video Tape, Audio Tape, Software, Test, Other __________________________________
PUBLISHER/PRODUCER CITY
COPYRIGHT DATE APPROX. COST PER ITEM
Is this request going to REPLACE an existing title? Yes No If YES, title:
YEAR ADOPTED: PUBLISHER: COPYRIGHT DATE:
If item is to be declared obsolete or in excess, complete APP. TO DECLARE INST MTLS OBSOLETE/IN EXCESS form.
COMPLETE COURSE TITLE FROM COURSE OUTLINE
CLASS IN WHICH ITEM IS TO BE USED GRADE LEVEL
SHOULD THIS ITEM BE ADDED TO THE COURSE OUTLINE? (Check one) YES_______ NO_______
COURSE OUTLINES ABOVE AND BELOW THIS GRADE LEVEL HAVE BEEN CHECKED FOR OVERLAPPING TITLES:
NO DUPLICATIONS DUPLICATION(S). (Attach rationale for duplication.)
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DEPARTMENT CHAIRPERSON'S RECOMMENDATION AND PRINCIPAL'S APPROVAL
The Department at School has reviewed this item and recommends it to the Board of Education for approval. We have consulted with our counterparts at the other middle/high school(s) of the district, and the counterparts agree with this recommendation.
Date Signature - Dept. Chairperson Signature – Principal / School
Date Signature – District Librarian EIC/SIC Date
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IF THIS INSTRUCTIONAL MATERIAL IS A FILM OR VIDEO, PLEASE RESPOND TO THE FOLLOWING QUESTIONS:
1) What is the length of this video/film (in hours and minutes)?
2) How is this video/film rated? (G, PG, R, NR, etc.) If rated other than G, or PG, explain why.
3) This video/film will be shown: a) in its entirety, or b) selected portions.
4) Approximately how much class time will be utilized in showing and discussing this video/film? (e.g., 3 class periods, etc.)
5) Indicate the Board approved instructional objectives which apply to the showing of this
video/film? (supply information if necessary)
6) Comments:
ASSISTANT SUPERINTENDENT'S RECOMMENDATION
Signature Date
Date Submitted to Board Date Approved By Board
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Note: When material is going to be used for a course taught at both the MIDDLE and HIGH SCHOOL(S), (e.g., Algebra I-P), or is part of a sequential program in grades 7-12, (e.g., English, social studies, foreign language), a book should be reviewed by teachers at the other schools to assure articulation.
Email Approval Sequence: Creating and/or forwarding this application through email indicates approval.
1. Originator drafts application and forwards by email to Principal.
2. Principal reviews application and forwards to District Librarian.
3. District Librarian will submit application to SIC/EIC by supplying copies of email approval path. If approved District Librarian will forward application through email to Assistant Superintendent who will forward form to Superintendent’s Office to be placed on Board agenda (thereby preserving approval path). Following board approval, all parties will receive the completed form via email.
LO:jj; 4/19/95; rev. 10/13/04; Doc. 6-App for Inst. Mtls. VIDEO App-Draft
Strategy 2.1: To develop a procedure to ensure that District curriculum and State content standards are aligned
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