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* 1. Organization name:

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* 2. Contact person:

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* 3. Contact person title:

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* 4. Contact e-mail:

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* 5. Organization Address:

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* 6. What is your organization's 2013 total budget? (Your answer should be one number.)

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* 7. Approximately how many videos did your organization produce in the past 12 months? Please distinguish between in-house and outsourced projects. If you would like to note the total minutes of produced video, there is a space provided.

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* 8. What is the single highest viewership your organization has achieved for an online video in the past 12 months? Please include link to view online.

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* 9. Approximately how many videos does your organization plan to produce in the next six months?

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* 10. How many staff hours per week does your organization devote to the production and distribution of videos? Do you have a full-time employee who is dedicated to video production?

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* 11. What equipment and software are you currently using to produce videos? Please be specific.

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* 12. Are you (or the person most responsible for producing video) interested in participating at least once a month in an online forum where Lights, Camera, Liberty! participants can privately share draft projects, get feedback and ask questions?

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* 13. This program may provide a 1-2 day on-site training visit at your headquarters from an expert filmmaker. What would you like a visiting filmmaker to emphasize during your site visit? (e.g. provide hands-on guidance on a specific project currently in production, give a broad overview of key tasks associated with video production, spend a majority of the time giving in-depth training on one or two key areas such as...) Also, is there a filmmaker or organization in your area that you would recommend to provide the training?

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* 14. If you are not selected to receive on-site training would you still like to considered for inclusion in the Lights, Camera, Liberty online forum?

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* 15. Please provide links to your organization's best video work (up to 3 videos).

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* 16. If you would like to share anything else about your organization and/or your plans to use video to achieve your mission, please describe below.

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