Please complete this form and email it along with a headshot of the Applicant (Cellphone photo quality ispermissible) to ALEFBoard@gmail.com. Scholarship recipient headshots/photos will be displayed during ourannual MLK Hope Breakfast.I, the undersigned, voluntarily consent to be photographed and/or videotaped. I understand that the intended useof the photograph/video tape(s), and my name, image and likeness is for publicity, education or public informationefforts for the Alpha Lambda Chapter of Alpha Phi Alpha Fraternity, Inc. (AL) and the Alpha Lambda EducationFoundation (ALEF) for print and the internet. I authorize any such use, by or on behalf of AL or ALEF, of thephotograph/video tape(s), and my name, image and likeness. I understand that I will not be paid or compensatedby or ALEF in any way for the taking or lawful use of any photograph/video tape(s), and my name, image andlikeness.I hereby release and discharge and ALEF, its members, agents and representatives from any claims, liability orresults caused by the lawful use of said photograph/video tape(s), and my name, image and likeness, which I havenow voluntarily authorized as a gift to and ALEF.