Insurance Communication Video Challenge Form

Organization information

Tell us about the university and registered student organization submitting the entry.

Name of university or college *This field is required. Name of registered student organization *This field is required. Primary submission contact name *This field is required. Primary submission contact email *This field is required. Primary submission contact phone *This field is required. Primary contact role or title *This field is required. The primary contact is the faculty advisor. Faculty advisor name *This field is required. Faculty advisor email *This field is required. Faculty advisor phone *This field is required. RSO office phone numberThis field is required. Faculty advisor campus mailing address *This field is required. RSO campus mailing address *This field is required. What is the stated mission of this organization? *This field is required. If selected as a winner, how will the organization use the award funds for the benefit of the organization and students? *This field is required.

Student content creators

Add every student who contributed to the submitted video.

Social-media use

Arrange the channels from most used to least used. Drag and drop them into order, or use the arrow buttons. Mark any channel your organization does not use as “Not used.” Rankings update automatically.

Ranked channels

Drag to reorder, or use the arrow buttons. Rankings update automatically.

1 Instagram Handle or URL
Not used
2 TikTok Handle or URL
Not used
3 LinkedIn Handle or URL
Not used
4 Facebook Handle or URL
Not used
5 Twitter / X Handle or URL
Not used
6 Truth Social Handle or URL
Not used
7 Threads Handle or URL
Not used

Not used

Channels marked “Not used” appear here with a rank of 0.

All seven channels are currently ranked.

Identify the top two social-media channels and provide the handles. *This field is required.

Release and waiver

One authorized representative must review and sign the waiver.

Release and Waiver

In consideration for the opportunity to participate in the Insurance Communication Video Challenge sponsored by the American Property Casualty Insurance Association (“APCIA”) and the Insurance Careers Movement (“ICM”) and for other good and valuable consideration, I irrevocably grant a perpetual, unlimited and exclusive license to APCIA and ICM, its respective licensees, successors and assigns to print, publish, broadcast, distribute, display, alter, edit, adapt, create derivative works or otherwise use for any purpose the Entry including, without limitation: the Entry, my name, picture, voice, likeness, or statements about the Contest, as well as, any submitted biographical information without compensation.

I acknowledge and agree that APCIA and/or ICM may post my RSO’s entry (“Entry”) on the Internet, including, but not limited to the APCIA and/or ICM website, facebook® page, YouTube® channel, X® account, or Linkedin® account and may allow both its members and the general public to view or comment thereon.

I waive any right to royalties or other payment for the use of the Entry, and I also waive the right to inspect or approve APCIA’s or ICM’s use of the Entry and/or other materials APCIA or ICM may use with it.

I attest that the Entry is my RSO’s and its content creators’ original work and that it does not contain any copyrighted material or violate the property rights of any other person.

I waive any and all claims against APCIA or ICM and their subsidiaries, affiliates, partners, representatives, agents, successors, assigns, employees, officers and directors for any loss due to a privacy breach and understand that any information submitted with an entry is subject to the Privacy Policy and Terms of Use located on the Insurance Careers Movement website.

I release and waive and agree to hold APCIA and ICM and their subsidiaries, affiliates, partners, representatives, agents, successors, assigns, employees, officers and directors harmless from any liability, illness, injury, death, loss, litigation, claim or damage that is proximately caused by my act or failure to act (whether negligent or intentional), my willful misconduct, or violation of law arising out of my participation in the Contest and/or acceptance, possession, use, or misuse of any prize or any portion thereof, including submission of my Contest entry.

I represent and warrant to APCIA and ICM that:

The Entry is original work created by my RSO’s content creators on behalf of my RSO.
Neither I nor my RSO have granted anyone else any rights to use, distribute, publish, broadcast, or display the Entry.
I and/or my RSO faculty advisor have obtained any permission or consents required by my school/university and the individuals appearing in the Entry in order to participate in this Contest.
To the extent the Entry incorporates my school/university logo, I and my RSO have obtained my school/university’s consent.
I and/or my RSO faculty advisor has the full right and authority to execute this Release and Waiver as one of the Entry content creators.
I and/or my RSo faculty advisor has all rights necessary to grant the rights, waivers, and releases granted in this Release and Waiver.
I have read this Release and Waiver and I fully understand it.
I have had the opportunity to seek independent counsel concerning this Release and Waiver.
All statements and information included in the Entry and any other statements and information that I provided to or will provide to APCIA and/or ICM are true and complete.

View or download the original Release and Waiver PDF

Waiver signer name *This field is required. Waiver signer email *This field is required. Signer title or role * Date signed *This field is required. I have read, understand and agree to the Release and Waiver, and I am authorized to execute it for this entry. *

Electronic signature of authorized waiver signer *

Sign with a mouse, trackpad or touchscreen.

Signature is required.

Entry files

Attach the video and supporting materials.

Contest video *MP4 or MOV, maximum 256 MBAttach a valid file. Video script *DOC, DOCX or PDFAttach a valid file. Team photograph *JPG or JPEG or PNG, maximum 1 MBAttach a valid file.

Faculty advisor approval

The faculty advisor must review and sign the final entry form.

I have reviewed this video submission and approve of its submission. I read, understand, and agree to the Contest Release and Waiver and provided a copy of the Contest Release and Waiver to all student content creators listed above prior to submitting this entry. *

Faculty advisor’s printed name *This field is required. Date signed *This field is required.

Electronic signature of RSO faculty advisor *