INTERN MEDIA RELEASE

INTERN MEDIA RELEASE
This authorization allows Workforce Solutions for North Central PA to use your name, photography, video, and/or likeness in connection with internship-related publications, promotional materials, news releases, website, social media, presentations, and other workforce development communications.
Intern Information
INTERN NAME:

First NameLast Name
INTERNSHIP POSITION / JOB TITLE:
EMPLOYER:
Authorization
I grant permission to Workforce Solutions for North Central PA to use my name, photograph, video, and/or likeness in connection with internship-related publications, promotional materials, news releases, websites, social media, presentations, and other workforce development communications.
INTERN SIGNATURE:
PRINTED NAME:

First NameLast Name
DATE:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you 18 or older?
PARENT/GUARDIAN SIGNATURE:
PRINTED NAME:

First NameLast Name
DATE:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Equal Opportunity Employer/Program Auxiliary aids and services are available upon request to individuals with disabilities. Funded in whole or in part by Federal Funds. Detailed information can be found at: https://www.workforcesolutionspa.com/categories/resources/pages/stevens-amendment
Should be Empty: