Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Making a Difference submission form
Thank you for your interest in the campaign. You will be contacted within three days about the best way to send your content after you complete the following.
Sign in to Google
to save your progress.
Learn more
Your name
Your answer
Your role
adviser
student
Other:
Clear selection
Your email
Your answer
School
Your answer
Media name
Your answer
Content type
Your answer
What was the date of publication/broadcast?
Your answer
Please include a short paragraph about the content and how it made a difference in your school or community.
Your answer
How did the affected community/communities react?
Your answer
Did the content undergo prior review?
yes
No
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
