Mid Story Submission

Name*

First NameLast Name

Email*

Phone Number*

Area CodePhone Number

Program of Study

How are you connected to Mid?*

Is this story about you or someone else?*

This story is about myself.This story is about someone else.

If this story is about you, complete the following questions.

If this story is about someone else, complete the following questions with their information (as much as you can). Thanks!

Name of Person Featured

First NameLast Name

Email of Featured Person

example@example.com

How are they connected to Mid?

Hometown

Tell us the story...*

Tell us about any distinguishing moments such as scholarships, awards/honors, international experiences, and personal connections that connect to the story.

May we contact you to talk more about this story?

Yes, please.No, thank you.

Upload Photos or Files connected to the story.

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Authorization

I authorize Mid Michigan College to use this testimonial information in marketing materials.

I hereby agree that the Board of Trustees of Mid Michigan College (the “College”), and those acting pursuant to its authority, shall have the right to record my participation, appearance, likeness and voice on videotape, audiotape, photograph, digital, electronic, or in any other medium and I hereby unconditionally and irrevocably consent to the College’s use of such materials for any legal purpose the College deems appropriate for the benefit of the College, including commercial and advertising purposes.

I also, hereby forever waive (i) any right to require payment from the College for the use of these materials by it or those acting pursuant to the College’s authority and (ii) the right to object to the use of such materials for any purpose permitted by this release, including, without limitation, the license or sale of such materials by the College and those acting pursuant to its authority who publish, print, display, exhibit, distribute, or otherwise publicly use any such materials for any legal purposes.

I understand that this release grants the College the right to edit, crop, retouch, or otherwise reasonably alter such materials, at its discretion, and, at its option, to reveal my name and identity in such materials or by descriptive text or commentary. I understand and agree that any intellectual property rights associated with such materials are the sole property of the College. Furthermore, I agree that this release shall be construed in accordance with the laws of the State of Michigan and if any term or provision of this release shall be held illegal, unenforceable, or in conflict with any law governing this release, the validity or enforceability of the remaining portions shall not in any way be affected or impaired thereby.

Signature*

Significant effort has been made to ensure this content meets accessibility guidelines. If you encounter a barrier you can report the barrier at midmich.edu/reportaccessibilitybarrier or contact Strategic Communications at (989) 386-6622 x579 or stratcomm@midmich.edu.

In its commitment to providing a safe environment, Mid Michigan College actively endeavors to broaden our diversity, promote equal opportunity, and prohibit any form of discrimination in its programs, activities, and conditions of admission or employment. Learn more about these efforts and policies by visiting midmich.edu/eeo, midmich.edu/titleix, midmich.edu/securityreport.

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