Public Relations & Communications Request Form

Public Relations & Communications Request Form

Thank you for requesting a service from Name's Blue Media! Please be sure to fill out all required sections so we may capture complete project intelligence, clarify deliverables, define timelines, and align stakeholders before production begins.
Client & Project Identification
Primary Contact

First NameLast NameSuffix
Position & Title
Example: "Executive Director of Organization LLC"
Your Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Website of Organization
www.example.com
What type of Public Relations Servies do you need?
Select the services that apply to your project.
Project Scope & Objectives
Request Title
Provide a short title for the project
Describe the situation, initiative, announcement, or communications need.
Communications Objective
Primary Objective
Target Audience
Desired Call-to-Action
What should the audience know, feel, understand, or do after receiving this communication?
Stakeholders & Spokespersons
Who are the primary stakeholders involved?
Will an official spokesperson be required?
Spokesperson Name

First NameLast NameSuffix
Spokesperson Title & Organization
Example: "Executive Director of Organization LLC"
Does messaging require approval from other departments, executives, legal counsel, elected officials, boards, partners, or agencies?
If yes, identify required approving parties:
Communications Sensitivity
Request Classification
Is any portion of this information confidential prior to release?
Embargo / Release Date: Are there legal, regulatory, privacy, personnel, or reputational considerations NBM should be aware of?
If yes, please explain without submitting privileged or restricted information that NBM is not authorized to receive.
Media & Distribution
Where will this communication be distributed?
Geographic Audience
Do you need media outreach?
Do you already have a media/contact distribution list?
Media/Contact Distribution List Upload

If you would like to upload your Media/Contact Distribution list for clearer direction or guidance on whom to send media to, upload here for assessment.
Cancelof
Supporting Materials
Any Supporting Materials for Upload?
Assets Upload

Please provide any current additional branding assets for this project.
Cancelof
Relevant URL / Source Links
For PR work, source material matters considerably because public-facing messaging must be factually supportable.
Deadline & Priority
Requested Publication / Release Date

MonthDayYear
Requested Completion Date

MonthDayYear
Is the release date fixed?
Priority Classification
Related Media Production
Does this PR initiative also require photography or video production?
If yes, additional media production information may be required.
File Delivery Method
Submission Review & Accuracy Confirmation
Do you authorize Name’s Blue Media to use approved photos, video footage, audio, graphics, or other content produced through this request for marketing, promotional, portfolio, website, social media, and business development purposes?
Please confirm that you have reviewed your request for accuracy and completeness, including grammar, spelling, names, dates, locations, contact information, and all project-specific details. Have you verified that all information submitted is complete and correct?
Select Your Preferred Billing Method
Should be Empty:

Public Relations & Communications Request Form

Client & Project Identification

What type of Public Relations Servies do you need?

Project Scope & Objectives

Communications Objective

Stakeholders & Spokespersons

Communications Sensitivity

Media & Distribution

Supporting Materials

Deadline & Priority

Related Media Production

Submission Review & Accuracy Confirmation