CLC-TV Schedule

2012 CLC-TV Student Video PSA Contest

One form per entry. Have all information and files ready before proceeding. Please review all rules in advance and verify that all information is correct before submitting. Deadline to submit is April 28, 2012 by 8 p.m.

PSA Title *

Please come up with a unique and creative title for your PSA. Title must match title on YouTube link.
Student Name * First Last
Please provide student's name
Student's Grade *

Indicate number grade (ex. 9th grade)
Student Name First Last
Two names required only if two students submitting for group PSA.
Student's Grade

Only if submission is a group PSA. Indicate number grade (ex. 9th grade)
School Name *

Enter the name of student's school.
Teacher/Contact Name * Title First Last Suffix
Please indicate contact name in case we have any questions or concerns. Indicate your teacher's name if class project. If not class project indicate parent or student's name that we may contact.
Teacher/Contact Phone # * - (###) - ### ####
Please indicate contact phone number in case we have any questions or concerns. Indicate your teacher's phone number if class project. If not class project indicate parent or student phone number that we may use to contact.
Teacher/Contact Email Address *

Please indicate a contact email in case we have any questions, concerns or announcements. Indicate your teacher's email if class project. If not class project indicate parent or student's email that we may use to contact.
YouTube Link *

Submit YouTube URL link here. Copy the URL link of your YouTube video and past here. Keep your video up on YouTube for the duration of the contest.
Form Upload

If you have any documents that need to be submitted such as parental release, standard release, references, or copyright permission forms please upload here from your computer.
Form Upload

If you have any documents that need to be submitted such as parental release, standard release, references, or copyright permission forms please upload here from your computer.
Form Upload

If you have any documents that need to be submitted such as parental release, standard release, references, or copyright permission forms please upload here from your computer.
Form Upload

If you have any documents that need to be submitted such as parental release, standard release, references, or copyright permission forms please upload here from your computer.
Form Upload

If you have any documents that need to be submitted such as parental release, standard release, references, or copyright permission forms please upload here from your computer.
References/Note

If applicable, student also have the option to type in references here. Any other notes or notes may be entered here as well.