Six Degrees Contest

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

How are you connected to Ivy Tech Community College? (Please select all that apply)*

Other relationship

File*

Submit a picture of your connection or video of your story to DOUBLE your entries.

Drop files here or

Max. file size: 50 MB.

Consent*

I agree to the contest rule and regulations

Contest rules & regulations:

By completing this form, you are consenting to allow the Ivy Tech Foundation to publish your name if you win the drawing.

Please note that awards $600 or over will be reported on the IRS Form 1099-MISC by Ivy Tech Foundation. The IRS has stipulated that amounts less than $600 are required to be self-reported by the recipient on their personal tax return. Consult with your personal tax advisor for any questions or concerns. Not redeemable for cash or any other services/products not already listed.

By completing this form, you are consenting to being an adult and voluntarily consenting to have your connection information, photograph(s) and/or video tape(s) used by Ivy Tech Community College. You understand that the intended use of the information, photograph(s), and/or video tape(s) is for publicity, education or public information efforts for Ivy Tech Community College for print and the Internet. You authorize any such use, by or on behalf of Ivy Tech Community College, of the information, photograph(s) and/or video tape(s) and understand that you will not be paid or compensated by Ivy Tech Community College in any way for the taking or lawful use of any information, photograph(s), and/or video tape(s). You hereby release and discharge Ivy Tech Community College and its employees, agents and representatives from any claims, liability or results caused by the lawful use of said information, photograph(s), and/or video tape(s) of yourself, which you have voluntarily authorized as a gift to Ivy Tech Community College.

Six Degrees of Ivy Tech