Ear Peace: Save Your Hearing Foundation Scholarship Application
NOTE: Entrants must comply with all contest rules or your video will be disqualified.
Use the form below to enter online.
Applicant Information
If applying as a team/group, please provide the information for the captain/leader.
Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Age *
Your answer
Grade in High School *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
High School Information
Name of High School *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Additional Applicants (only if applying as a team)
If applying as an individual, please leave this section blank.

If applying as a team, please provide the information for any of the other members of the team (do not repeat the information for the captain/leader provided above).

Name of Team Member 1
Your answer
Email of Team Member 1
Your answer
Age of Team Member 1
Your answer
High School Grade of Team Member 1
Name of Team Member 2
Your answer
Email of Team Member 2
Your answer
Age of Team Member 2
Your answer
High School Grade of Team Member 2
Name of Team Member 3
Your answer
Email of Team Member 3
Your answer
Age of Team Member 3
Your answer
High School Grade of Team Member 3
Name of Team Member 4
Your answer
Email of Team Member 4
Your answer
Age of Team Member 4
Your answer
High School Grade of Team Member 4
How did you hear about the Ear Peace Foundation PSA Scholarship? *
Required
Upload your PSA entry to the Internet (i.e.: Youtube, Vimeo, or SchoolTube). PSA must be uploaded BEFORE submitting this entry form to Ear Peace Foundation. Once your PSA has been uploaded, simply copy the URL of the video and paste it below. *
Your answer
I have read and understood the Official Rules for the Ear Peace: Save Your Hearing Foundation Scholarship. These rules can be found at https://goo.gl/ecu5UU *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Ear Peace Foundation. Report Abuse - Terms of Service