Western Nevada Community College Authorization To Be Interviewed/photographed
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1Western Nevada Community College
AUTHORIZATION TO BE INTERVIEWED/PHOTOGRAPHED
Date: ___________________
I ___________________________________________________
(Name)
HEREBY GIVE MY PERMISSION TO BE
PHOTOGRAPHED _______ AND/OR INTERVIEWED _________ .
I AUTHORIZE THIS INTERVIEW/PHOTOGRAPH TO BE USED IN
NEWSPAPER ARTICLE
TELEVISION/VIDEO RELEASE
COLLEGE NEWSLETTER
COLLEGE RESEARCH
COLLEGE WEB SITE
OTHER: EXPLAIN __________________________________________________________________
_______________________________________________________________________________________________
________________________________________________________
(Signature)
_______________________________________________________
(Signature of witness and/or parent or guardian if subject is under the age of 18.)
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