Media Coverage Request – Burrell College of Osteopathic Medicine Forms

Please use this form to request media coverage for an upcoming event, informational, or marketing purposes.

Requester Name(Required)

First Last

Requester Email(Required)

Requesting Department or Organization

Requester Phone Number(Required)

Coverage Needed(Required)

Videography

Photography

Written Article

Date Coverage is Needed(Required)

Time Coverage Begins(Required)

Time Coverage Ends(Required)

Filming times are:(Required)

Flexible (Videographer can provide alternative dates if these conflict with scheduled events).

Inflexible (Select if the filming is for an event or if there are no other dates that work for your filming needs)

Request Details(Required)

Please describe the type of video you are in need of. Examples of video requests include event coverage, informational style videos, marketing content, interviews style videos, etc. Please provide a detailed description of what is needed.

Individuals to be Recorded

Please list the names of anyone who needs to be interviewed/recorded for this video production. All individuals must have provided their consent to be recorded prior to filling out this form. Note: If requesting filming at an event, you do not need to list the attendees.

Associated Content

Drop files here or

Accepted file types: jpg, pdf, doc, png, gif, heic, docx, , Max. file size: 20 MB.

Please upload any associated content needed for filming. This includes event flyers, organization logos, scripts, interview questions, supplementary images, etc.