Release Form for Advertising, Publicity, and Display Materials

I give permission to GVSU in general, and specifically to the Center for Undergraduate Scholar Engagement, including offices and programs therein, to use my likeness in any medium and for any lawful purpose, including promoting the institution, its programs and services and to note my affiliation with their programs.

* denotes a required field

Identification Information

First Name *

Last Name *

Email *

Phone *

Major (if applicable)

Check all that apply: *
Freshman
Sophomore
Junior
Senior
Graduate Student
Fac/Staff/Other
Community Member
Alumni

Center for Undergraduate Scholarly Engagement Office *
Frederik Meijer Office of Fellowships
Office of Undergraduate Research and Scolarship

Signature *

(This agreement fully represents all terms and considerations and no other statements, conditions, or promises are made in conjunction with this release form).

With this signature, I give permission to GVSU to use, without charge and without reservation, my likeness in any medium and for any lawful purpose, including promoting the institution, its programs and services. I waive any rights of action I may have and release GVSU and its licensees from any and all claims I may have arising from use of my likeness, including any rights to sue for defamation or violation of my rights of privacy or publicity.

Human Verification *

Page last modified May 1, 2023

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