Application Form
This is a consent for release of information and media for program promotional purposes only. I Print your name* authorize the Chicago Urban League to release or obtain information that may be used only for the purpose of assisting me in my pursuit of career or employment. I also authorize the Chicago Urban League to use videos and photos for program promotional purposes. I understand I have the right to see this information at any time. I understand that I can revoke this consent in writing to both the person giving and the person receiving the information. Any information already released may be used as stated on the consent. I understand the requested or provided information is needed to determine eligibility for services. This consent is valid until December 31, 2023.