EmailMe Form - ReelLIFE SCIENCE 2020 Application Form

SECTION 1: YOUR SCHOOL OR YOUTH ORGANISATION
Tell us about the school or youth organisation you are representing with your ReelLIFE SCIENCE video.
School or Youth Organisation *
With this entry, are you representing a school or youth organisation?
School or Youth Organisation Name *
School Roll No. *
For Youth Organisations, please enter 'N/A'
Teacher/Youth Worker Name *
First Last
We may need to be able to contact an adult (teacher/youth worker) about your video. Please do not use your own name unless you are a teacher or youth worker.
Teacher/Youth Worker Email *
We may need to be able to contact an adult (teacher/youth worker) about your video. Please do not use your own email address unless you are a teacher or youth worker.
Teacher/Youth Worker Phone *
We may need to be able to contact an adult (teacher/youth worker) about your video. Please do not use your own phone number unless you are a teacher or youth worker.
Number of Students/Youth Members Involved *
Class(es)/Year(s) Involved *
Junior Infants
Senior Infants
First Class
Second Class
Third Class
Fourth Class
Fifth Class
Sixth Class
First Year
Second Year
Third Year
Fourth/Transition Year
Fifth Year
Sixth Year
Tick all classes/years involved in making the video
Age range of youth members involved *
Enter age range of youth member(s) involved in making the video (e.g. 11-14)
Address - Street *
Please enter the address of your school or youth organisation.
Address - Town *
Address - County *
Twitter (e.g. @ReelLifeScience)
Optional. Leave blank if your school or youth organisation does not use Twitter.
Website or Social Media
Optional. Leave blank if your school or youth organisation does not have a website or social media page
SECTION 2: YOUR VIDEO
Tell us about the short science video you've made for ReelLIFE SCIENCE
Competition Theme *
Please select the theme your video best falls under, e.g. is it a video about Climate Action! or How Things Work? If you are not sure where it fits, just select Science and Me!
Video Title *
Give your video a good name to differentiate it from others. It will generally get more views on YouTube too!
Video YouTube Link *
Please make sure the link to your video is working and the YouTube video privacy settings are set to 'PUBLIC'. Videos set to 'PRIVATE' or 'UNLISTED' may not be viewable and cannot be included. This is REALLY important!!!
Video Language *
Copyrighted Material Included? *
No
Please tick 'No' to confirm that copyrighted material (images, music, sound recordings, video clips (e.g. TV, movies, online videos) etc.) has not been used without permission in your video. Please use royalty-free or original music in your video.
Parental Consent received? *
Yes
Please tick 'Yes' to confirm that all necessary permissions and releases from all persons appearing or identified in the video or any associated photos/still images have been obtained.
Agree to Terms & Conditions? *
Yes
Click 'Yes' to confirm you have read and agreed to the Terms and Conditions (http://reellifescience.com/teachers-tips/terms-and-conditions/)
SECTION 3: ALMOST THERE
Help us make ReelLIFE SCIENCE even better in the future. Your answers will not affect the outcome of the competition.
How did you first hear about ReelLIFE SCIENCE @ HOME? *
If 'Other' please specify
e.g. name of newspaper, website, etc. where you first heard about us

TAKING PART IN ReelLIFE SCIENCE... *

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree
...has made me more interested in STEM.	1	2	3	4	5
...has improved my knowledge of STEM.	1	2	3	4	5
...has improved my communication skills.	1	2	3	4	5
...has improved my video production skills.	1	2	3	4	5

Please use this box for any feedback you would like to give us about ReelLIFE SCIENCE.
Your feedback helps us improve ReelLIFE SCIENCE for future participants, so feel free to tell us what you did or didn't like.
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SECTION 1: YOUR SCHOOL OR YOUTH ORGANISATION

SECTION 2: YOUR VIDEO

SECTION 3: ALMOST THERE