IQ Innovation Contest

Please provide your information and responses to the questions in the fields below.

* Required fields

First Name *

Last Name *

Phone Number *

Email Address *

YouTube Channel Link *

YouTube Channel ID *

Country of Residence *

United States

State/Province of residence *

Select your Profession *

Professional License Country *

United States

Professional License State/Province *

Professional Title *

(as written on your License)

Licensing Authority *

(example: “Medical Board of California”)

License Number *

What is your high-level vision of your digital video presence? *

250 words remaining.

Why are you interested in investing in video as a format for health information sharing? *

250 words remaining.

Why do you want to participate in the YouTube Health’s THE-IQ program, creating high quality health content for underrepresented communities? *

250 words remaining.

How did you find out about this program? *

250 words remaining.

Please list 3-5 of your YouTube videos that showcase high quality health content for underrepresented communities. *

I certify that I am 18 years or older and agree to be bound by the Official Rules. *

By checking this box, I am confirming my acceptance of the YouTube privacy policy. *

By checking this box, I attest to be bound by the CMSS/WHO/NAM Information Sharing Principles *

By checking this box, I am confirming acceptance to my data being stored in the US. *