Interview Form

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	Proposed Date(s) of Interview:
	1st choice:	/ /
	2nd choice:	/ /
	3rd choice:	/ /

	Length of time requested:
	Purpose for this interview:
	Number of cameras at interview:	TV Still

	Discussion Points: (500 character max)

	Attending (include names and positions) (NOTE: Only people listed will be admitted to this interview - 500 character max)



	Name of interviewer:
	Position/Title:
	Media organization:
	Type of media organization:	Print TV Radio Other

	Address:
	City/State/Zip:

	Phone:
	Fax:
	Email:
	Website address:

	Additional Comments: (500 character max)

	Attaching a file?	Yes No
	Attach any additional information or questions:

	PLEASE NOTE: You will be notified within two weeks of the submittal of this form as to whether your request has been granted or denied. If you are requesting a date that is more than 45 days away, you will not receive final determination until your requested date comes within that time frame.