WEAU Community First

Organization Information:

Organization Name:*

Mission Statement:*

Contact Information:*

Non-Profit Organization's 501(c)(3) Number*

Target Audience:*

Topic:*

Briefly describe the topic or issue you would like to address in the PSA

Do you already have a PSA produced?*

YesNo

If Yes, upload here: https://www.dropbox.com/request/w9nFjlCQtmJ6gmEFBwuq

If you are providing a PSA already produced, you can skip the next section.

PSA Request Details:

1. Is it an event?

2. Name of the Event:

3. Description of the Event:

4. Date and time of the event:

5. Location of the event:

6. Who will benefit from this event?

7. Expected number of participants (goal):

8. Is the Event open to the public?

9. Is there a cost to participate?

10. Expected funds raised after expenses?

11. How will the funds be used locally? (Do all funds stay local? If not, please elaborate.)

12. Expected expenses (venue rental, supplies, etc.)

13. Target Audience:

Who is the intended audience for this PSA?

14. Key Message:

What is the main message you want to convey in the PSA?

15. Call to Action:

What specific action do you want viewers to take after watching the PSA?

16. Timeline:

When would you like the PSA to be produced and aired?

17. Existing Materials:

Do you have any existing materials (e.g., scripts, footage, audio) that can be used in the PSA?

18. Website/Social Media:

Organization's Impact:

1. Reach:

How many people are you able to reach with your organization's programs and services?

2. Impact:

Can you provide examples of the positive impact your organization has had on the community?

3. Partnership:

Does your organization collaborate with other media organizations or agencies?

Additional Information:

1. Budget:

Do you have any budget allocated for the PSA production and/or airtime?

2. In-kind contributions:

Are you able to offer any in-kind contributions in exchange of the PSA. (exclusivity, tickets to event, logo on promotion)

3. Previous Partnership:

Have we created a PSA for you before?

4. If yes, when?

5. Other requests to be included with partnership:

Would you want a WEAU Anchor as MC?

6. What would be the responsibilities and approximate time commitment (including pre-event meetings)?

7. Station Involvement:

Do you have a contact at WEAU that invited you to apply? (Please write their name and position)

Please enter your date of birth.*

You must be at least 18 years of age to fill out this form.

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You have read Gray Local Media, Inc.'s Standard Terms and Conditions at https://graymedia.com/about/terms-of-use and agree to those terms in full.

Client and partners have read Gray Local Media, Inc.'s Standard Terms and Conditions at https://graymedia.com/about/terms-of-use and agree to those terms in full.