Satellite Request Form

Please note:
Please provide all required information (* indicates required field) and submit the form at least 48 hours in advance of scheduled downlink. (Weekends/holidays not included). A Media Library staff member will confirm the availability of the requested program. For more information see Satellite Downlink Page.


Today's Date:
Name:*		Department:*
Phone:		E-mail:*
Box #:

Title of Satellite Broadcast Program:*

Sponsor / distributor:*

Broadcast Date:*

Start Time (CT):*

End Time (CT):*

Test signal time (CT):*

Do you wish to have this program recorded on videotape?*

Yes

If yes, please enter your initials to verify you have copyright permission to record this program.

Provide own tape

Media Center tape

Do you wish to arrange a direct viewing of this program?*

Yes

Preferred site of viewing:

(You may call 2725 for more information about scheduling rooms)

	LRC Room T (up to 35 people - call Dr. Schmidt 5191 for availability)
	LRC Room 221 (call Scheduling Center 5800 to reserve room)

Other room location

Satellite Technical Information
(Please include both sets of coordinates if given)

C-Band Coordinates

Satellite:

Orbital Location:

Signal Type:

Digital

Analog

Unspecified

Transponder #:

Channel :

Downlink Frequency (MHz):

Polarity:

Vertical

Horizontal

Unspecified

Audio Frequency (MHz):

Ku-Band Coordinates

Satellite:

Orbital Location:

Signal Type:

Digital

Analog

Unspecified

Transponder #:

Channel :

Downlink Frequency (MHz):

Polarity:

Vertical

Horizontal

Unspecified

Audio Frequency (MHz):

Broadcast Telephone Help Number:

Copy of license receipt must be provided before transmission date
(Please forward any program registration information or forms to Media Library Box 33)

License Fee:*

Date Paid:

Paid By:*

Additional Information: