All information is held in strict confidentiality. AAOA is not required to fund the full requested amount. AAOA may run out of funds and the funds awarded are on a first come first serve basis. All documents requested are needed for this application to be complete. Failure to provide documents may result in a delay processing your request.
I grant permission to AAOA including any and all of its subsidiaries, licensees, successors, assignees, and any and all other individuals, agencies, corporations, organizations etc. acting on behalf of AAOA (whether by this or any other names and/or designations and henceforth collectively referred to as the Released Party)-- to obtain and use as the Released Party sees fit the voice, image, photograph, likeness, video, and/or any other form of media as it develops (henceforth collectively referred to as Likeness) of myself by any medium (including but not limited to video, audio, photo, and/or any media as it develops/evolves or other image, natural or altered in any state by any manner).
I verify that the information listed above is true. I understand that making a false statement may result in legal action, repayment of all funds received from AAOA and/or forfeiture of any AAOA assistance in the future. All information is subject to verification.