Photo, Video, and Media Consent Release Form
I give the American Indian College Fund permission to use my photograph and video, or my child's photograph and video, for print and electronic fundraising, public education, media publication, and marketing purposes in any and all manner, including with third party organizations and partners that support the College Fund, for the promotion of Native higher education and scholarship support, in perpetuity. I also understand that the College Fund may use AI in editing or other circumstances but will not use AI in a manner that depicts my likeness or image, or my child's likeness or image, in a false or deceptive light. If signing on behalf of a minor child, I represent that I am the parent or legal guardian of the child and have the authority to grant this permission.
Name
*
First
Last
Tribal Affiliation
School
Major
Minor's Name (if applicable)
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Additional Notes
Feel free to share details about your submission (is this part of a specific project or intended recipient at the College Fund?)
I am a College Fund scholarship recipient.
*
Yes
No
Not sure
Signature
Submit
Submit
Should be Empty: