CONSENT FORMS Contact Release I agree to allow the College of Education to share my name, email address, and phone

number with other students in my cohort for class and travel purposes. Please check ____ Yes ____ No Liability Coverage Acknowledgement I understand that participation in the Statewide program requires inter-island travel. I understand that the University of Hawai`i-Manoa, College of Education requires that I assume all liability related to such travel and that I carry liability insurance. The College strongly recommends that all students carry medical coverage. Signature of Student____________________________________ Date__________________ Photo Release Permission to Record, Broadcast and/or Publish Electronic Sound or Image** The following release form is a document of understanding regarding permission to display or broadcast an individual’s image or work by or through the University of Hawai`i, College of Education and its various projects and endeavors. My signature on this form acknowledges my agreement with the terms below. I hereby give my permission to the University of Hawai`i, College of Education to record and display, electronically or otherwise: _____________________________________________________________________________ (printed name) I understand that any recordings will be used exclusively for educational purposes and to promote University of Hawai`i programs, which may include open-circuit (broadcast), closed-circuit, cable television transmission, DVD/CD distribution and/or Internet and Web publication within or outside of the State of Hawai`i in perpetuity and that the College of Education will hold the copyright of the resulting recordings and all ancillary materials. I also understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission, distribution or playback, and that the University of Hawai`i, is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result. The College of Education may use my name, likeness and/or bibliographical identification for publicizing and promoting the use of these recordings and to further the development of the project. SIGNATURE: _________________________________Date______________________________ ** Note: this release allows us to take photos in class for brochures, ads, projects, and other uses related to the functioning of the College. Stipend Agreement I understand that travel stipends for flights and accommodations are provided to me based on the expectation that I enroll and pay for the courses in this program. I am aware that if I drop a course, withdraw from the program, or receive a travel stipend and do not attend the associated course(s) for any reason, I am obligated to repay the College of Education immediately. __________________________________________ Signature _____________ Date

Mail to Arlene Garcia, Everly Hall, Room 124, 1776 University Avenue, Honolulu HI 96822

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