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 entry, please complete and print this form. Submit it with all of your TVA materials according to the contest rules. Submission deadline is 4 p.m. on March 4, 2013.

Please make sure all of your TVA materials are completed.

1. Indicate whether this is an individual entry or team entry by checking the appropriate box in the Entrant Information section.
2. Fill in the contact information on the left side of the page. For team entries, the team captain should fill in the team information on the right side of the page on their entry form only.
3. Fill in the video category and video title.
4. Read the Entry and Authorization information and Irrevocable License and Release statement. Check the appropriate boxes below the statement. Fill in your name, sign your name, and fill in the date.
5. If you are or will be age 18 or older as of March 4, 2013, initial the line that says, “Initial here if Participant is above the age of 18.”
6. If you are under age 18 as of March 4, 2013, have your parent or legal guardian complete the section on Consent of Adult on Behalf of Minor. Your parent or legal guardian must fill in their name, sign their name, and fill in the date.
7. Your sponsoring teacher must 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 fill in their name, sign their name, and fill in the date.
8. Mail or deliver your completed entry and contest forms to:
   

   HMSA Teen Video Awards Contest
   Hawaii Department of Education
   Attn: Katherine Sakuda
   475 22nd Ave., Room 119
   Honolulu, HI 96816

   Phone: (808) 203-5542

   OR

   HMSA
   Attn: Tai Leong
   818 Keeaumoku St.
   Honolulu, HI 96814

   Phone: (808) 952-7989