First Name	Last Name
Address
City	State/Province
Country	Zip/Postal Code
Date of Birth (Month/Date/Year) (Example: 05/11/1995)	Grade Level
Email	Phone

First Name

Last Name

Email

My parent/guardian does not have an email address.

Phone

Every student entry needs a sponsoring teacher of counselor to sign off on the project. This may be your film, journalism or English teacher or your school counselor. They'll have to respond to some automated emails to ok your entry to the contest. Tell them to keep their eyes out for emails from Young Minds Digital Times.

Sponsoring Teacher First Name	Last Name
Sponsoring Teacher School Name	Sponsoring Teacher Phone
Sponsoring Teacher Email
School Address
City	State/Province
Country	Zip/Postal Code

 I have read the rules and guidelines to this competition and agree to follow them.

How did you hear about this competition?
  My teacher
  My parent/guardian
  A Friend
  Converge magazine publication
  Online newsletter or list serve
  I participated last year
  Facebook
  Twitter
  Blog
  Other