Carnegie/Notable Children's Videos Application/Submission Form
Title _______________________________________________________________________________
Running Time ______________ Copyright Date _______________ US Release Date ____________
Purchase Price ________________ Rental Price _____________________
Producer _____________________________ ____ US Citizen/Resident Yes___ No¬____
Street Address _______________________________________City____________________________
State _____ Zip __________ E-Mail Address _________________________
Telephone _________________ FAX ___________________
Distributor __________________________________________________________________________
Contact Name _______________________________________________________________________
Street Address ___________________________________________ Telephone __________________
City _____________________________ State ______ Zip _________ FAX ______________________
E-Mail Address _________________________ Web site URL:
Has this title been previously released in another format? No _____ If yes _____, explain
_____________________________________________________________________________________
Is this title part of a series? No _____ Yes _____ Series Title __________________________________
Are public performance rights available for library programs? No ______ Yes ______
Do you wish to have your video returned to you after the committee has evaluated it?
No ____ Yes ____ If yes, please enclose postage and a mailing label.
Please send a copy of this form with each video to the Committee Chair and the ALSC Office. In order that more than one member of the committee may view a video, please consider also sending videos with submission forms to the other committee members. If you have any questions, please contact the committee chair:
Maeve V. Knoth (Chair, 2012 - 2013)
519 Prospect Street
San Carlos, CA 94070-2025
e-mail: visser-knoth@plsinfo.org
ALSC Office
Attn: Carnegie Submission OR Attn: NCR Submission OR Attn: Carnegie/NCR Submission
50 East Huron Street
Chicago, IL 60611
Submission Deadline: December 31, 2012
