YouTube Scholarship Contest Entry Form

Please Note: Incomplete entry forms with incorrect information will not be accepted.

An "*" next to a question indicates a required field.

Legal Name
First Name:*
Middle:
Last Name:*
Mailing address and contact information
Mailing Address:*
City:*
State/Province:*
Zip Code:*
Country (if not US):
Primary Telephone:
Email Address:*
Gender:	Male Female
Date of Birth:*
Video Information
Video Title:*
Video URL:*
I have read and understand the official contest rules. If under 18 years of age, my parent/legal guardian has given me consent to enter this contest. * I Agree I Disagree
The video I am submitting does not contain any copyrighted, inappropriate, or otherwise prohibited content. * I Agree I Disagree