HIV Project

People living with HIV 1 Project Submission Form

Hey there! Thank you for your interest in our project featuring Latinx people living with HIV 1.
Please fill out the survey below ASAP. It should only take a few minutes. Once submitted, you may be contacted by a GENUINE Casting Team member with follow-up questions or requests.

If selected for the final project, you will be paid $750 for each shoot day plus $5,000 for usage. The final project is a digital and print ad featuring real people with HIV 1 and shoots in June.

If you experience difficulty taking this survey or have questions about the project, please contact GENUINE at casting@genuinerp.com

If you have any questions about the information you provide to us, you can read GENUINE's Privacy Policy.

Okay, let's get started!
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
City*
City, State
Home State*

Are you legally permitted / allowed to work in the United States?*

YesNoI don't know

During this survey, we will be asking you about your medical history/health as it relates to HIV. Please select "I agree" below if you are willing to share information about your health as it relates to HIV.

MEDICAL CONDITIONS

Subject to your agreement to the waiver below, please share information regarding any medical conditions that you may have and are comfortable discussing publicly for potential projects. You acknowledge and understand that your personal health information may be protected from disclosure by the Health Insurance Portability and Accountability Act ("HIPAA") and other privacy laws. By selecting, "I agree" below, you are knowingly waiving your rights under HIPAA and any other privacy laws and consent to GENUINE electronically storing the personal health information that you disclose and reviewing it for purposes of contacting you about future projects for which you may be suited.
By selecting one of the options below, you acknowledge that you have read and understand the above statement.*

I agree to waive my rights under HIPAA and any other privacy laws and permit GENUINE to store and access my personal health information for purposes of contacting me for projects.I decline to provide my personal health information.

If asked, would be you able to get a Doctor's Note confirming your HIV 1 diagnosis?*

YesNo

For this project, we want to feature people engaging in activities that they love, so we'd like to learn more about you, your life, your interests, and what makes you unique.
What do you do for a living?*
What do you do outside of work for fun? Ex: Passions, Hobbies, Activities, etc. *

Do you play an instrument? Are you a creator or crafter? If "yes", please tell us about this. If "no", please write "N/A".*
Are you a pet owner? If "yes", please tell us about your pet(s). If "no", please write "N/A".*
What is going on in your life that you would like to share?*

As a part of the final selection process, would you consent to a Background Check?*

YesNo

Please upload a recent photo of yourself.

Browse Files
NO sunglasses, hats or edited/photoshopped photos. NO filters. We must be able to see your [real] face. Cancelof

Have you ever worked as/been paid to be an actor or model?*

YesNoI don't know
Have you ever been featured in a project for TV, Film, Commercial, Digital, etc.? If "yes", what project(s)? Please note if you have representation i.e. an agent and/or manager.*
Have you appeared in any medical, pharmaceutical or healthcare marketing communication/advertising?*

YesNoI don't know

What type of medical, pharmaceutical or healthcare marketing communication/advertising did you appear in?*

GENUINE is always looking for people to share their stories and appear in paid advertising campaigns for major brands including American Express, Chipotle, and Walmart to mention a few.

If you would like to hear about our latest casting opportunities, join GENUINE's mailing list.

YOU ONLY NEED TO REGISTER ONCE, so if you receive our emails, please check, "I am already on the GENUINE Mailing List". Thank you!
Would you like to be added to GENUINE's mailing list?*

Yes! I would like to join GENUINE's mailing list and agree to permit GENUINE to store and access my contact information for purposes of contacting me for future casting opportunities.No, I decline to join GENUINE's mailing list at this time.I am already on the GENUINE mailing list.

Thank you so much for taking the time to answer all of our questions.

Please click on the "Submit" button to complete your survey.
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People living with HIV 1 Project Submission Form