Education PSAs DVD Order Form
Three 30-second Public Service Announcements (PSAs) titled Dreams, Test, and Gift were developed in part by the
Truancy Reduction Demonstration Project in Hawaii and the College of Education, University of Hawaii. The messages
are designed to positively affect an individual's value of and attitudes about education. Online versions of the PSAs are
available at www.educationpsa.org.
Instructions: Complete the form and submit as described below.
 Yes. I certify that I/we will use the Education PSAs DVD for educational purposes only.
Name:
School/Agency:
Address:
Number and Street (or P.O. Box)
City
Email:
Phone: (
State
)
Fax: (
Zip Code
)
SURVEY: Please answer the following questions to help us understand how you learned about and intend to use the Education PSAs DVD.
1. How did you learn about the Education PSAs and/or the www.educationpsa.org website?
 Television broadcast.  Web search/referral.  Email.  Other:
2. How will you and/or your school/agency use the Education PSAs DVD? (Check all that apply.)
 With children/youth.  With parents/families.  With businesses/agencies.  Other:
3. Do you anticipate that the Education PSAs videos will be broadcast?  Yes.  No.  Not sure.
If "Yes," how will the videos be shown?  Television (network/cable).  Closed circuit.  Other:
Make a copy of the completed form for your records and send the original by fax to (808) 956-2740 or mail to:
Education PSAs
LEI Aloha, Educational Technology
College of Education, University of Hawaii
1776 University Avenue, Wist 245
Honolulu, HI 96822
If you have any questions/comments about the Education PSAs DVD and how to order it, or to check the status of your
order, please email us at [email protected] or call (808) 956-7341. And visit the Education PSAs website at
www.educationpsa.org and share your ideas and comments about the PSAs and Education PSAs DVD.
Note: We ship all orders via U.S. Postal Service Priority Mail with Delivery Confirmation. If you provide an email address above, we will send your tracking number by email.
For office use only. Do not write in this area.
Order Number:
Date Form Received:
Processed By:
Date Processed:
P.O. Invoice # (if any):
Date P.O. Invoice mailed:
Date Payment Received:
Check Number:
Date Order Shipped:
Tracking Number(s):
Note:
Copyright © 2006-2008. College of Education, University of Hawaii. All rights reserved.
Form revised: 08/13/08