Use Application-Appendix A Relationship to Drake University: Who Is Name of Requestor: Undergrad Student Requesting The Drone? Department (if applicable): Conference Grad Student ROTC Name of Supervisor (if applicable): Faculty Bon Appétit Staff Conference Email Address: Visitor/Guest Contractor Other Business Phone: Mobile Phone: Federal Aviation Administration Name of Operator: Who Will Be Small UAS Certificate Operating The Drone: Registration Company Name (if applicable): CertificateHolder:__________ Company Address: Certificate#: Issued: Expires: Email Address: Business Phone: Mobile Phone: What Is The Please Explain: Purpose Of The Flight? How Will The Please Explain: Photos Or Will the photos or be posted on the internet or on social media? Yes No Footage Be Used? If yes, which sites: Will the drone be used to capture recognizable images of Drake University signs and campus buildings? Yes No If yes, Marketing Communications must approve this drone usage request. Will the drone be used to capture recognizable images of individuals? Yes No If yes, how will this personal information be protected (check all that apply)? The faces of individual that are recognizable will be blurred. The individual that are recognizable will sign a photo/video release. The drone will only capture images or video of large groups at a distance and resolution where individual recognition is not easily accomplished. Other (please explain): Will signs be posted to inform bystanders that their images may be recorded by drones? Yes No If yes, will the sign also inform bystanders about who to contact if there are concerns about how the video footage will be used? When Will The Drone Be Flight Date: Flying? Start Time: AM PM End Time: : AM PM Flight Date: Start Time: : AM PM End Time: : AM PM & Camera Model of Drone: Will still photos be taken using the drone: Yes No Information Drone Serial #: If yes, what image resolution will be used? Model of Camera: Will video be taken using the drone: Yes No Combined weight of Drone & Camera: If yes, what video resolution will be used? Map the campus map in this document or one operator provides, please mark the perimeter boundary where the drone will be flying.
Use Application-Appendix A Who Is Requesting The Drone? Name of Requestor: Department (if applicable): Name of Supervisor (if applicable): Email Address: Business Phone: Mobile Phone: Relationship to Drake University: Undergrad Student Conference Grad Student ROTC Faculty Bon Appétit Staff Conference Visitor/Guest Contractor Other Who Will Be Operating The Drone: Name of Operator: Company Name (if applicable): Company Address: Email Address: Business Phone: Mobile Phone: Federal Aviation Administration Small UAS Certificate Registration CertificateHolder:__________ Certificate#: Issued: Expires: What Is The Purpose Of The Flight? Please Explain: How Will The Photos Or Footage Be Used? Please Explain: Will the photos or be posted on the internet or on social media? Yes No If yes, which sites: Will the drone be used to capture recognizable images of Drake University signs and campus buildings? Yes No If yes, Marketing Communications must approve this drone usage request. Will the drone be used to capture recognizable images of individuals? Yes No If yes, how will this personal information be protected (check all that apply)? The faces of individual that are recognizable will be blurred. The individual that are recognizable will sign a photo/video release. The drone will only capture images or video of large groups at a distance and resolution where individual recognition is not easily accomplished. Other (please explain): Will signs be posted to inform bystanders that their images may be recorded by drones? Yes No If yes, will the sign also inform bystanders about who to contact if there are concerns about how the video footage will be used? When Will The Drone Be Flying? Flight Date: Start Time: AM PM End Time: : AM PM Flight Date: Start Time: : AM PM End Time: : AM PM & Camera Information Model of Drone: Will still photos be taken using the drone: Yes No Drone Serial #: If yes, what image resolution will be used? Model of Camera: Will video be taken using the drone: Yes No Combined weight of Drone & Camera: If yes, what video resolution will be used? Map the campus map in this document or one operator provides, please mark the perimeter boundary where the drone will be flying.
Drone%20Procedures%20and%20Forms.docx