2017 Clean Air Challenge Submission Form
The Environmental Health & Asthma Subcommittee (EHAS) of the APS School Health Advisory Board (SHAB) is pleased to lead the Arlington community in a celebration of Clean Air Awareness Month.

We are organizing a Clean Air Challenge for APS students to create Public Service Announcements that encourage people to take steps toward cleaner air.

Please complete one entry form for each public service announcement and list all student(s) who contributed to the project. The deadline is Friday, March 31.

After filling out this form, please email your electronic files to arlingtoncleanair@gmail.com.  The following formats are acceptable: .doc, .docx, .pdf, .ppt, .jpg, .png, .mov, .wmv, .flv, .mp4

We also require that a parent or guardian complete a permission form for EACH student who contributed to the project: http://bit.ly/CleanAirChallengePermission
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First Name of Student *
Last Name of Student *
Student Grade *
School Attending *
Names and grade levels of additional student(s) contributors
Parent First Name *
Parent Last Name *
Email *
Phone
Title of Submission *
Type of Submission *
Required
Description of submission *
Dimensions of submission (non-digital visual art)
I understand that a permission form must be completed by a parent/guardian for each student participating.   *
Required
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