Appendix B

Darien Public Schools

Educational Access Programming Bulletin Board Posting Form

Name of Person Requesting ________________________________________________

Phone Number(s) of Person Requesting _______________________________________

Requested START and END dates for airing ________________ Thru ______________

Exact Details of Information to Be Aired (Please provide a “layout” of the information as you hope it will appear, or staple as an attachment)

The above content has been viewed in its entirety and I verify that it complies with all the requirements listed in Board of Education Policy #JB3 and Administrative Procedures sections a through k for School Sponsored Information Media.

Signature of Person Requesting _________________________________ Date ________

Signature of Staff Posting Information to air__________________________ Date _________

School Administrator’s Signature (if requested) _______________________ Date _________

The completed, signed, original copy of this form MUST be filed in the logbook of the Darien Public Access Channel, prior to airing the information, unless it is an emergency message requested by Central Office Administration, in which case the form should be filed soon after the fact.