EXTERNAL FILM REQUEST FORM

External Film Request Form

This form is to be completed by external production companies requesting to film on Belmont University's campus. The form is to ensure the needs of the production company are met and coincide with the Belmont University vision and policy.

For convenience, the word "filming" has been utilized throughout this form, and represents any of the following: motion pictures, filming, videotaping, still photography, digital imaging, and audio recordings.

The University recognizes the right to prohibit any filming on Belmont owned property that creates potential for any of the following: disruption to academic, research, business, or student activities; damage or alteration to university property; inappropriate use of Belmont's name, image, logos, or trademarks; disruption of traffic, parking, or pedestrian pathways; violation of the University's privacy policy; or any other safety hazards.

Please contact the Office of University Scheduling at (615) 460-6786 or scheduling@belmont.edu with any questions regarding this request.

* = required field

Name of Production Company:*

Tax ID #:*

Email Address:*

example@example.com

Phone Number*

Format: (000) 000-0000.

Full Name:*

First NameLast Name

Email Address:*

example@example.com

Phone Number:*

Format: (000) 000-0000.

Full Name:

First NameLast Name

Email Address:

example@example.com

Phone Number:

Format: (000) 000-0000.

Full Name:

First NameLast Name

Email Address:

example@example.com

Phone Number:

Format: (000) 000-0000.

Who is responsible for signing the permit on behalf of the production company?

Full Name:*

First NameLast Name

Title:*

Proposed Filming Date:*

MonthDayYear

Arrival Time:*

Hour Minutes

AM/PM Option

Departure Time:*

Hour Minutes

AM/PM Option

Filming Hours:*

Proposed Filming Locations:*

Proposed use of the material filmed on university property:*

Number of filming crew members:*

Number of actors and extras:*

Number of vehicles (trucks/trailers/cars) requested to be parked on university property for purposes of film production:*

Vehicle Descriptions:*

Would filming require connection to university electrical power sources/outlets for lighting or other electrical needs?*

YesNo

If yes, what voltage/wattage will be required?

Connectors?

Would the production company provide its own generators?*

YesNo

Would any altering of campus property be involved (ex: construction, painting, etc.)?*

YesNo

If yes, please explain:

Would any university services be required for purposes of the production, such as parking spaces, security, electricians, alarm system personnel, internet service, etc.?*

YesNo

If yes, please explain:

Does this production involve the use of weapons, simulated weapons, smoke, explosive devices, and/or other materials that could alarm other members of the university community?*

YesNo

Please include the type and a brief description of the filming project.*

Please upload the most recent version of the film script:*

Electronic Signature:*

Type your full name to serve as your acknowledgement of the information set forth herein.

Production Company

Executive Producer

Executive Director

Location Manager

Filming Details