William T. Young Library

 HOURS for July 10, 2020:  

Media Exhibition Questionnaire

This form must be completed by anyone planning to exhibit audiovisual media (VHS tapes or DVDs) not in the AV Media Collection at Young Library; it should be filled out by the owner of the tape or DVD to be exhibited. If it is part of the Young AV Media Collection, please reserve the item using our online form to ensure it will be available on the day you wish to show it. To find out if it is in the Young Library collection, please search for it using InfoKat (UK's Library Catalog).

For AV media you are bringing, please submit this Media Exhibition Questionnaire no later than 24 hours prior to the scheduled event. For weekend events, questionnaires must be submitted by 3:00 p.m. on the preceding Friday. Information will be used to determine if the exhibition conforms to Fair Use Guidelines under copyright law, in which case AV Services will deliver all equipment needed. AV Services will also deliver equipment if Public Performance Rights have been obtained. Please fill out a separate form for each item you plan to exhibit.


Full name:

College, Department, Organization:



Reservation Date:

Reserved Room:

Title of Media:

I understand that I may not substitute this title without prior approval.

VHS  DVD    Digital download (requires proof of purchase)

Required viewing for course -- Course number:

I/My Teaching Assistant will be present during the program.

Media is being exhibited in conjunction with a conference, seminar, etc.

Attendees are paying a fee to attend conference, seminar, etc.

Public Performance Rights have been purchased for this item.


Please check all boxes that apply:

Not copyrighted, or copyright is held by exhibitor (Please describe in "Comments" area below.)

Department copy

Rental copy

Personal copy

Obtained from commercial vendor.

Copy made from original tape or DVD **

Contains excerpts from other videos.

Recorded off of television -- Date recorded:

Access is restricted to a particular group -- Group:

Event is open to the public.


Theatrical film

Showing program in its entirety.

Showing excerpts transferred from original.

Media is supplemental to presentation.

Media represents entire presentation.

I'll be charging admission or taking donations from attendees:
Requires written permission from copyright holder, a copy of which must be provided to AV Services at least one week prior to event. Also, anyone planning to solicit money or donations of any kind on campus must present written permission signed by the Dean of Students, and must be part of a registered student organization with the University. That written permission should be taken to Young Library Security Desk upon arrival for your event.

   ** Please note that any copy (i.e., dub) to be exhibited must be accompanied by documentation from the copyright owner or the owner's agent (i.e., distributor), printed on letterhead stationary or conveyed via other official means, verifying that it is approved for public exhibition. Failure to provide proper copyright documentation, or verification that the program is in the public domain, may result in AV Services being unable to support your request. If you have questions about the authenticity of the copy to be exhibited, please call AV Services at 218-1879.

Additional Comments:


After receiving notification that your exhibition is approved under Fair Use Guidelines and/or Public Performance Rights, please plan on delivering your tape or DVD to the Audiovisual Service Desk (Young Library basement) no less than 30 minutes prior to the time your event is to start. Thank you.


this request.

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