Community Program Request Form

Community Program Request Form
Submitting as a
NLTV Community Creator: are clients certified with Nā Leo TV to use NLTV equipment, studios, or edit bays and are Hawai‘i Island residents.
Hawaiʻi Island Presentors: are clients who submit programs completely created with outside resources and are not certified.
File Name
Program Title
ex: (Audrey Wilsonʻs Cooking Show, Culture Corner, Etc.)
Episode #/Title
Description of Program
Program Length

Hour Minutes
Video on Demand (NLTV COMMUNITY CREATOR ONLY)
Does this Program contain Mature Content?
Category (Check One)
(FOR NLTV COMMUNITY CREATORS ONLY) TIME SENSITIVE:
Program must be aired within a specific time frame to be relevant. If yes, add dates below.
Start Date Date End Date Date
Name of Producer

First NameLast Name
Signature
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
If you are NOT the Copyright Holder, attach a permission letter with a signature and contact information below. Please inform NLTV Staff when your contact information has changed. For more information regarding submission requirements or to review a copy of the Public Access Policies & Procedures click here or visit our website naleo.tv and look under resources.
Attach a File (not required)

This is for any signed permission letters and contact information for Copyright holder.
Cancelof
Today's Date

MonthDayYear
For record purposes
Should be Empty: