Social Media Campaign Contest Application To be considered for the High School Distracted Driving Social Media Campaign contest, please fill in the information below as completely and accurately as possible. Questions? E-mail us at email@example.com High School InformationSchool Name*School Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School County:*Type of School*ex. Public, private, charter, etc.Principal Name*Principal Email* Are you a teacher or an advisor?*TeacherAdvisorTeacher InformationTeacher Name* First Last Teacher Title & Department*ex. Health TeacherSchool Phone & Extension*Teacher Cell Phone*Teacher School Email* Teacher Alternative Email Advisor InformationAdvisor Name* First Last Advisor Agency/Organization*School you will be working with on project*Office Phone*Cell Phone*Email* Student/Team Leader InformationStudent Name* First Last Student Email* Student Grade*Agreement & LiabilityBy submitting an application for the contest, entrants agree to the following: “I certify that I will abide by all guidelines, rules, and requirements of the Distracted Driving Social Media Campaign.” “I understand that if our campaign makes it past the first round, I must upload the requested project social media content into the folder I am provided within two (2) days so our entry can be included in the final round of judging.” “I understand that Impact Teen Drivers will utilize my entry via Impact Teen Drivers social media if I am a finalist.” “I will ensure all appropriate photo release forms for the school have been completed.” “I will ensure all social media content used for this campaign is appropriate and reflects well on my school.” Release of Liability Participants, by receipt of an educational grant in this Award Contest, hereby waive and release, and agree to hold harmless the Sponsor, all promotions and advertising agencies, and their respective parents, subsidiaries, affiliates, distributors, advertising and promotions agencies and all of their respective officers, directors, employees, representatives, and agents, from and against, any and all rights, claims, and causes of action whatsoever that they may have, or which may arise, against any of them for any liability for any matter, cause or thing whatsoever, including but not limited to any injury, loss, or damage, whether direct, compensatory, incidental, or consequential, to person, including death and property, arising in whole or in part, directly or indirectly, from their acceptance, possession, use, or misuse of the educational grant in the Contest, or their participation in the Contest, or their participation in any Contest or educational grant related activity, or any travel related to the Contest or any travel for any educational grant related activity.EmailThis field is for validation purposes and should be left unchanged.