SHIFT NC

PSA Competition Entry Form

Please submit one of these entry forms for each video entry. 

You must submit your video separately by mail or email - you can't upload it here.

All entries and forms must be submitted by September 14th at 5pm. Entries received without this form will be considered incomplete. 

By submitting this form, you are agreeing to let APPCNC use your video, in whole or in part, for educational and marketing purposes. 

Official Entry Form

<p><strong>PSA Information</strong></p>
Just to help us stay organized, give us the titles of the other PSAs you have submitted or plan to submit.
<p><strong>Group Entry Information</strong></p>
If you are entering as a group, please provide your group name.
(Groups are not required to be Teen Health Now chapters to enter.)
<p><strong>Individual Entry Information</strong></p>
<p><strong>Permission Form</strong></p> <p>By checking the following box and providing my electronic signature (initials), I consent to let APPCNC use my PSA, in whole or in part, for any future educational or marketing purposes. I agree that I have the express permission to use any people, sounds, or images provided in my PSA. I understand that the PSA I have submitted will be uploaded to APPCNC&#x27;s public YouTube page and shared through the APPCNC website and APPCNC&#x27;s social media accounts. I understand that if my video does not meet the competition rules, my entry will be considered incomplete and invalid. I understand that the winner of the PSA competition will be determined solely by votes collected on the APPCNC website.&#160;</p>
Please type your initials in the box to confirm that you agree with the terms above.