CA PBIS Video Contest Submission Form
The purpose of this video contest is to highlight the work on positive school culture, that schools are doing, during the 2019 CA Positive Behavior Intervention & Supports (PBIS) Conference in Sacramento, CA. Schools and districts, using video to support their PBIS systems and practices are encouraged to submit an entry.

Please connect with the site administrator in charge of PBIS on your campus and review the Rules & Regulation and Release Form. Please check out this form and complete if applicable: https://tinyurl.com/CAPBISRules-Regulations
Email release forms to lcampo@placercoe.k12.ca.us

The deadline to submit a video is September 15, 2019. Schools who are named winners will be notified at the conference on October 28th.

Prizes will go to the top three videos and the money must be used to support positive school culture incentives happening at the school . The contest awards will be presented during the CA PBIS conference in Sacramento, October 28 & 29.

Any questions please email: Liz at lcampo@placercoe.k12.ca.us

Note - If you are submitting more than one video you must complete a separate form for each video. Also, you do not need to be present at the conference to enter a video. Thanks for submitting and using video to support your PBIS efforts!

Name of the lead person submitting the video (first last) *
Your answer
What is your email address? *
Your answer
What is your school or districts name? *
Your answer
What city, state, and country is your school or district located in? *
Your answer
Title of the video: *
Your answer
Do you have written parent permission to film students? *
Paste a link to the video here: *
Your answer
Who is the intended audience of the film? *
Required
Please select a primary category: *
Required
Please select the student grade level(s): *
Please select a secondary category: *
Required
Do you or a colleague plan on attending the PBIS Conference in Sacramento? *
Required
List name(s) of co-creators: *
Your answer
How did you use this film in your school or district? *
Your answer
Thank you for your submission!
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