PUBLICATION REQUEST FORM

Requesting Unit/Campus: ___________________________________ Date: _______________

A. Purpose of Publication_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C. Category of Information (Please check below)

________ Memorandum ________ Photo News

________ Advisory ________ Announcements

________ Policy ________ News/Feature Article

________ Tarpaulin Lay-out ________ Others, pls specify ____________

D. Where do you want to publish?

________ PSU Echoes ____________ PSU Facebook Page

_________Local Newspaper ___________ PSU Website

________ National Newspaper ____________ Tarpaulin

E. Risk if not Published

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

F. Target Date of Publication: ____________________________________________________________

G. Target Audience/Recipients: ___________________________________________________________

H. Name of the Sender: __________________________

Position: ____________________________________

Date: _____________________________________

-------------------------------------- TO BE FILLED IN BY PRPIO PERSONNEL --------------------------------

H. Evaluation Criteria (Please check)

___________ Relevance

___________ Timeliness

___________ Completeness of Data

I. Action Taken

_____________ Approved

____________ Not Approved Reason/s: _________________________________________________

K. Received by

Name/Signature: ____________________________________________

Date Received: ______________________________________________

Time Received: ______________________________________________