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FERPA Photo/Interview Consent Form

The Family Educational Rights and Privacy Act and the Washington Administrative Code 504-21-010 prohibit WSU’s release of a student’s educational records, other than directory information, without a signed release from the student. The photographs and interview comments constitute educational records under those laws.

SID(Required)

Please include a leading "0" as the first digit of your ID number, i.e. 099999999.

Student Name(Required)

First Last

Student Email(Required)

Example: butch@wsu.edu

Major(Required)

Year(Required)

Home Address(Required)

Department(Required)

Department Email(Required)

Example: butch@wsu.edu

Are you 17 years of age or under?(Required)

Yes

Terms of Consent(Required)

By clicking "Submit" below, I grant permission to Washington State University (WSU) to photograph me or otherwise have images or voice recordings made (including but not limited to digital photographs, video or digital moving images and/or voice recordings), for WSU publication or promotional purposes in any medium (including but not limited to print media, newspaper, television, video, motion picture, or Web site or use on the Internet).

I additionally consent to the use of my name and/or interview comments in connection with WSU publication or promotional purposes in print media, newspaper, television, video, motion picture, or Web site on the Internet.

I understand that consent to use my likeness or voice recordings is not a condition of participating in the activity and that consent can be refused without any impact in the ability to fully participate in the program. No inducements or promises beyond my acceptance of an opportunity to promote WSU and its programs have been given to me.

Any other use of images and/or recordings, my name, and/or interview comments requires advance permission. I understand that I can revoke this consent at any time upon notice to WSU, at which time I will sign a copy of the denial (below) for use of images or voice recordings.

I agree to these terms of consent.

Student Signature(Required)

Please type your full name as your digital signature.

First Name Last Name

Parent/Guardian Signature (if under 18)

Please type your full name as your digital signature.

First Name Last Name

Date