Date _____________________, 20____
Name of organization / group
We wish to distribute promotional materials electronically on the following dates: (The District uses a third-party flyer management system to electronically publish promotional material. A fee may e charged for this service.)
Month Date(s) Year
There (will) (will not) be a charge for the instruction/activity.
The person who may be contacted, if necessary, about the content of this literature, by the school, parent, or other recipient of information is:
Name __________________________________________________________
Address ________________________________________________________
_______________________________________________________________
Zip code
E-mail address _______________________________________________________
Phone: (work) ________________________ (home)________________________
I/We hereby assure the school that the organization will:
- Agree that any charges for the instruction/activities will be based on and not exceed the cost of providing the instruction/activities;
- Not use fighting words, obscenities, defamatory speech or encourage disruption of the educational environment;
- Not provide representations or visuals that are inappropriate as described in The Children's Internet Protection Act;
- Remove the material on a date certain not more than one (1) month after it has been distributed or five (5) days after the activity begins, whichever is earlier;
- Label all material with the name of the sponsoring organization;
- Provide the name, address and telephone number of the local representative for the organization prominently on the promotional material;
- Display the following disclaimer prominently on the material:
"The Chandler Unified School District neither endorses or sponsors the organization or activity represented in this material. The distribution or display of this material is provided as a community service."; and - Have an authorized representative of the organization sign the written assurances.
The promotional material and assurance form affirming compliance shall be provided to the school office at the same time.
This request must be submitted to the school office at least two (2) weeks prior to the requested date(s).
________________________________________________________________________
________________________________________________________________________
Signatures and titles of organization representatives
FOR SCHOOL USE ONLY
Date:_________________________ Principal _______________________________
Action
______ Denied or requested alteration for the following reason(s):
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______ Approved