MCPS Form 236-12 - Request to View MCPS Security Camera Video

Sep 19, 2026

MCPS Form 236-12 (October 2024) provides a controlled process for requesting access to security camera video recorded on MCPS property. The form directs that a school administrator completes Part I after an external request, then sends it to OSSEM for review, export, and preservation. OSSEM coordinates authorization from the principal, OSSI, and OGC before the requestor views the video in Part III, and OSSEM distributes the completed form. The form also covers preservation details and the final review steps by the school administrator.

LanguageEnglish

CategoryForms

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

Instructions

Part I: Requestor (To Be Completed by School Administrator)

Part III: Authorization

Part IV: Review of Video (To Be Completed by School Administrator)

MCPS Form 236-12 October 2024 Page 1 of 2 | Request to View MCPS Security Camera Video | | | --- | --- | |

CLEAR FORM | Office of School Support and Improvement (OSSI) Office of Systemwide Safety and Emergency Management (OSSEM)
Office of the General Counsel (OGC) MONTGOMERY COUNTY PUBLIC SCHOOLS (MCPS)
15 W. Gude Drive Rockville, Maryland 20850 | | INSTRUCTIONS | | --- | | Video footage recorded by MCPS security cameras may depict misconduct, a serious incident, and/or criminal conduct on MCPS property, including a school bus. This form should be completed by MCPS school administration after receiving a request by someone outside of MCPS to view a security camera video, including students, parents/guardians, and law enforcement.
Part I should be completed by an MCPS school administrator and then sent to OSSEM for review, export, and preservation of the video. OSSEM will arrange for review of the video by the school principal, a representative from OSSI, and a representative from OGC. The principal, OSSEM, OSSI, and OGC must all authorize the viewing of the video by the requestor in Part III of this form.OSSEM will distribute the completed form as noted.
For more information, see MCPS Regulation EGF-RB, Retention and Disclosure of MCPS Video Records, which provides guidance for school staff when viewing, preserving, or disclosing videos from MCPS security cameras. | | PART I: REQUESTOR (TO BE COMPLETED BY SCHOOL ADMINISTRATOR) | | Requestor name: Date of Request: / / Requestor is: o Parent/Guardian of Student
o Eligible Student o Law Enforcement o Other (specify)
Requestor contact phone number: / / Email
REASON FOR THE REQUEST:
Please describe the reason the requestor is requesting to view MCPS security camera video, including a description of any incident(s), incident location(s), date(s), time(s), etc.
| | Date MCPS security camera video was reviewed and exported by OSSEM: / / Time: : o a.m./o p.m.
Name of OSSEM Reviewer: Names of any other MCPS staff members reviewing the video:
PRESERVATION:
Location where video footage is being preserved: Saved title of video footage: Date saved: / / Are images of multiple students and/or MCPS staff members contained on the video: o Yes o No
If yes, describe: | MCPS Form 236-12 Page 2 of 2 | PART III: AUTHORIZATION | | --- | | Reviewed by:
1. Reviewed by Representative from OSSEM Name and Title: OSSEM Representative Signature: Date: / /
2. Reviewed by Representative from OGC Name and Title: OGC Representative Signature: Date: / /
o Yes o No If no, reason:
PART IV: REVIEW OF VIDEO (TO BE COMPLETED BY SCHOOL ADMINISTRATOR) | | Security camera video was viewed by the Requestor Named in Part I on (date): / /
Location where the security camera video was viewed: Who was present when the security camera video was viewed? (all names other than Requestor, including titles)

Note: Under no circumstances are MCPS staff authorized to provide copies of videos from MCPS security cameras without approval from OGC. | Distribution: Original/Completed form should be maintained in a secure file in the Principal’s, Copy/OSSEM

FAQs

Who completes Part I of MCPS Form 236-12?

Part I is completed by an MCPS school administrator after receiving the request from someone outside MCPS.

What authorization is required before the requestor can view the video?

The principal, OSSEM, OSSI, and OGC must all authorize the viewing by the requestor in Part III.

Are MCPS staff allowed to provide copies of MCPS security camera videos without approval?

No. The form states that under no circumstances are MCPS staff authorized to provide copies of videos without approval from OGC.

Sep 19, 2026

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