Form Instructions
Entry Form
For the HMSA Teen Video Awards Contest, students, working individually or in teams,
compete to create and produce the best public service announcements on a teen health
issue.
To submit a TVA individual entry, please print and complete this form. Submit it
with all of your
TVA materials according to the
contest rules. Submission deadline is 4 p.m. on March 3, 2008.
Please make sure all of your TVA materials are completed.
- Write in all of the information requested in the student information section.
- In the video information section, check if this is an individual entry or a team
entry, and check the video category.
- Write in your video title, a brief description, and the name of your team leader.
- Read the entry and authorization information and irrevocable license and release
statement. Print your name, sign your name, and fill in the date.
- If you are or will be age 18 or older as of March 3, 2008, initial the line that
says, “Initial here if Participant is above the age of 18.”
- If you are under age 18 as of March 3, 2008, have your parent or legal guardian
complete the section on Consent of Adult on Behalf of Minor. Your parent or legal
guardian must print their name, sign their name, and fill in the date.
- Your sponsoring teacher needs to verify that the work submitted is your original
work, review copyright information with you, and make sure all of your necessary
forms are completed. Your sponsoring teacher must print their name, sign their name,
and fill in the date.