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Student Release Form

Student Release Form

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Published by Will Banks
Student Release Form
Student Release Form

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Published by: Will Banks on Sep 12, 2013
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09/12/2013

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Student Release Form Symmetris Gohanna (Calhoun Community College) During the course of the semester, student work

(writing, artwork, photographs, observations, etc.) is collected. Your work may be used for educational and instructional purposes to improve teaching in the following ways: 1. 2. 3. 4. Traditional face-to-face class instruction, On-line classes, Professional development, and/or Publication.

By signing this release form, you will have the privilege of participating in the education of both students and teachers. I, _________________________________________hereby give consent for my work to be used in the ways listed above. I further authorize Symmetris J Gohanna to use the above mentioned material in whole or in part, in any manner that she deems ethically appropriate, including any reproductions thereof and to identify students appearing in reproduced material by first name and last initial only. I also waive any right I may have to inspect and/or approve the material, and release Symmetris J Gohanna from any and all liability which could result from its use. I give permission I do not give my permission (please do not sign below if you do not give permission) Student's Name: _______________________________________ Address: _____________________________________________ ____________________________________________________ ____________________________________________________ County: ______________________________________________ Phone: _______________________________________________ Student Signature: ______________________________________ Date: _____________________

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