Video ContestEntry Form

Contest Information

The Kentucky Association of Sexual Assault Programs and the Kentucky Office of the Attorney General seek entries from eligible applicants for a Video Contest to increase awareness of the National Sexual Assault Hotline: 1.800.656.4673 or 1.800.656.HOPE.

In order to be eligible, contest entries must follow the prescribed formats outlined in the official entry packet and contest rules and must be postmarked prior to the deadline for entries. Please see contest rules for more information at

Eligible Applicants

Eligible Applicants

All applicants must be enrolled full or part time in a publicor not-for-profit college or university, including the Kentucky Community and Technical College System, located within the Commonwealthof Kentucky.

Applicant/Lead Producer Information
Name
Mailing Address
City ST ZIP Code
Phone
Email
College/University
Co-Producers
Name
Mailing Address
City ST ZIP Code
Phone
Email
Name
Mailing Address
City ST ZIP Code
Phone
Email
Name
Mailing Address
City ST ZIP Code
Phone
Email
Video Title and Length
Brief Summary of Video
Release and Acknowledgements

I, ______, acknowledge that:

I am enrolled full/part time in a public or not-for-profit college or university located within the Commonwealth of Kentucky.

I have not been employed or otherwise worked in a professional capacity within the film industry.

I have not been charged with or convicted of a crime involving intimate partner violence including but not limited to sexual assault, assault, domestic violence or stalking.

I have not been named as a respondent to an order of protection, including but not limited toan emergency protective order, domestic violence order or stalking protective order.

I understand that the entries must be in keeping with sponsors’image. Sponsors of this contest reserve the right to disqualify from participation any film determined by the sponsors or selection committee have the sole discretion to disqualify any entry from the contest.

I have read and agree to the Official Rules and Video Guidelines.

I understand that the sponsors will communicate solely with the lead producer.

______

Signature of Lead Producer*Date

*By signing above you are agreeing to be the main contact person for the Sponsors and will be responsible for communicating with the sponsors and other producers.

______

Signature Date

______

Signature Date

______Signature Date

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