Appendix 3A     Multimedia Element Request Form

Please complete one request for each multimedia element that you would like created. Your request will be examined before being forwarded for development. You will be contacted if there are questions or concerns about your request.

Author contact information:

Your name: ______Peter  Reiter________________

Your school board: ___Toronto Catholic___________

Your e-mail address: zbigniew.reiter@tcdsb.org____

Your phone numbers:______905-508-1260

Your course code:____SCH3UOC_____________

Metadata:

Title of Multimedia Element:   Combustion_of Octane

Placement of Element in Course (i.e., unit, activity, page): __Unit 3 Activity 4____________

Keywords Describing Element (1 to 10) (e.g., trigonometry, national pride, landforms, job skills):  
__combustion___, __ chemical reaction_, _________, ____percent yield___, ___limiting reagent_, __octane___, __oxygen gas___, ____carbon dioxide___, ____water___, _________________ 

Learning Style(s) Addressed with Element (select all that apply):

•	
•	Bodily-Kinesthetic
•	Interpersonal
•	Intrapersonal
•	Logical-Mathematical
•	Musical-Rhythmic
•	Verbal-Linguistic
•	Visual-Spatial

Teacher Learner Strategy in Element (select all that apply and identify specific strategies).  For a list of specific strategies, refer to Checklist for Teaching / Learning Strategies.

•	Activity-Based Strategies ____________________________________________________________
•	Arts-Based Strategies ______________________________________________________________
•	Cooperative Strategies _____________________________________________________________
•	Direct Instruction Strategies _________________________________________________________
•	Independent Learning Strategies _____________________________________________________
•	Inquiry and Research Models ________________________________________________________
•	Technology / Media-Based Applications ________________________________________________
•	Thinking Skills Strategies ____________________________________________________________

Background Context and Instructional Purpose of Multimedia Element:

In order for developers to create an effective multimedia element, it is critical that they understand 
it’s context and purpose. Please provide the following information in the spaces provided below.  

Background context – What teaching and learning challenges will this object address?

Instructional purpose – What will students learn in this object?

Instructional context – What overall and specific curriculum expectations are met through this object?  Note: you must include at least one overall expectation.  If appropriate, what Catholic Graduate Expectations are addressed in this object?

Code	Expectation	
QCV.02	Investigate quantitative relationships in chemicals reactions, and solve related problems;	
QCV.07	Conduct an inquiry to determine the actual yield, theoretical yield, and percentage yield of the products of a chemical reaction;	
CGE2b	Reads, understands and uses written materials effectively	

Element description – How would you describe your element outside of the context of your course?  Summarize your element in one to two sentences without referring to your course.  (E.g., “This video shows a WWW II veteran describing how he killed a German soldier and how this event changed the rest of his life.”)

 
What combination of multimedia elements do you want to incorporate in your resource / object?

•	Animation
•	Audio 
•	Drag and drop (match, categories, sequence)
•	Fill-in-the-blank
•	Glossary (interactive multimedia)
•	Graphing tool
•	Interviews
•	Label drawing and print
	•	Label with narration
•	Narration
•	Quiz show (NOT Jeopardy)
•	Roll over or mouse over
•	Simulation
•	Song
•	Teacher presentation/demonstration
•	Video
•	Other (explain below)

Examples of these elements may be viewed from the ODN site – LO Examples.

Other:

Copyright Notice

It is illegal to use images, text, videos, sound recordings, and other materials that were created by and/or belong to others.  You are responsible for ensuring that no such materials are used or submitted in or with this multimedia request and/or for submitting the appropriate documentation with such materials.    

If you wish to submit a graphic or an image along with your request, you may safely use one from any software that is Ministry licensed, including Smart Ideas, Microsoft Word, and Star Office.  Graphics from the Internet are NOT acceptable, unless they are noted as belonging to the public domain.  In this case, you must indicate what caption must appear along with the graphic.

If you intend to photograph, videotape, or create an audio recording of any person, you will need to have that person or his/her guardian complete a model release form.  

Please see your copyright package for more details about Ministry copyright procedures.

Does any portion this multimedia request depend upon third-party material, including items in the public domain?  If so, please provide details below: 

Instructions to the Developers:

Title (What will appear at the top of the screen): Combustion of Octane
	
Whitespace (What will the screen look like? – include a sketch, text, images, buttons, etc)

	
Script (What is to be narrated for this screen?)  (Added here and to script table)

Notes and Actions (What will happen on the screen, step by step? animations, interaction (with buttons, icons, etc), feedback to user, etc)  

	
Reviewer Comments

	

Script ( the script that you want recorded indicating voice, gender, etc)	
Screen #

	
Screen #

	

Final checklist:

Have you done the following?

•	Completed all the required areas of this form?

•	Attached all files related to this request, including images, worksheets, and any other files associated with this request?

•	Included transcripts of all audio and video components contained in the object?

•	Ensured that you are not violating copyright in any way?

•	Saved a copy of this form on your computer?