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Request for Waiver for the Instructional Use of Film

About this Form

Form number: 365-21

Audience:  School Staff

Last revised: July 2016

Related Forms

Form 365-25 - Record of Evaluation of Instructional Materials

Montgomery County Public Schools (MCPS) professional staff planning to use a film that does not comply with Motion Picture Association of America (MPAA) age ratings as required by MCPS Regulation IIB-RA, Evaluation and Selection of Instructional Materials and Library Books, must submit this form to request a waiver. Completed MCPS Form 365-25, Record of Evaluation for Instructional Materials, must accompany this form.  Provide all information requested on the form, secure required signatures, and submit the form to the Pre-K-12 Content Supervisor, Office of Curriculum and Instructional Programs, CESC, Rm. 269. If a waiver is granted, it is the responsibility of all teachers to notify parents/guardians and secure written parent/guardian permission before showing the film to students enrolled in the identified course.

Adobe PDF Request for Waiver for the Instructional Use of Film46 KEnglish

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