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STUDENT FILM/VIDEO/STILL PHOTOGRAPHY

UCLA CAMPUS LOCATION CONFIRMATION


Student: Adrien Husson Ph #: 310-592-8721 ID#: 403751072
Instructor: Belinda Starkie Ph #: 562-304-6326 Class: FTV 400/151
Felt like a day
Name of film: _________________________________________________________________________

Date of Shoot: 01/31/2009 Time: 10am-5pm


Number of Cast / Crew: 6 people Total Hours: 7
Location (specific): Dashew Center for International Students

____________________________________________________________________________________

Synopsis of Shoot: A man spends a typical day at work.

____________________________________________________________________________________

List All Production Equipment and Vehicles: HPX Camera, lighting equipment,
2 cars.

Check all applicable:


Weapons: (description)

FX: (description)

Stunts: (description)

Picture Vehicles: moving / stationary (type)

Facility requirements: Staff:


Other:
Estimated costs $

Location and Payment approved by:

FACILITY MANAGER SIGNATURE DATE

PRINTED NAME

CAMPUS ADDRESS EXTENSION

CAMPUS EMAIL

Student Location Confirmation rev. 11/3/06

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