What message would you like to share with the supporters of your scholarship? 

We encourage you to submit a photo to add personalization to your message. To ensure the best possible photo print quality, we recommend a color photo in .jpg file format (300 dpi resolution), with an uncluttered background. If you do not have photo editing software, we recommend the free online photo editing tool pixlr.com.

By signing this release (the “Release”), I hereby grant, assign, and transfer to The University of Connecticut Foundation, Incorporated, the University of Connecticut, the State of Connecticut, and their respective agents, representatives, licensees, successors, and assigns (collectively, the “Photographer”):

1. The absolute, irrevocable, perpetual, and unrestricted right and permission to use, reproduce, exhibit, display, modify, perform, create derivative works of, reuse, publish and re-publish any photographs, videos, and/or audio taken of me and/or that may include my name, image, likeness, voice and/or other personally identifiable information in relation to my participation in the Foundation’s scholarship recipient survey (the “Pictures”) in whole or in part, individually or in conjunction with other material, in any and all media now or hereafter known, including, but not limited to, print, the Internet, social media sites, digital communications, and electronically, and for any purpose whatsoever, including but not limited to, education, research, illustration, promotion, commercial, art, editorial, fundraising, annual reports, newsletters, flyers, posters, advertising and trade materials, without restriction as to alteration, and without payment or any other consideration 
2. The use of my name, image, likeness, voice, and/or other personally identifiable information associated with the Pictures in connection therewith if the Photographer so chooses; and
3. Any and all of my right, title, and interest in the foregoing.

I understand and agree that the Pictures shall be the property of the Photographer and I am not entitled to receive the Pictures or any copies or originals thereof. I understand and agree that I will have no right to review or approve the Pictures or any finished product in which my name, image, likeness, voice, and/or or other personally identifiable information appears including written or electronic copy, and irrevocably waive any rights, claims, or interests I may have therein.

I hereby release, hold harmless and forever discharge the Photographer and its officers, directors, employees, agents, representatives, and affiliates from any and all claims, demands, damages, and causes of action that may arise out of, or in connection with, the use of the Pictures, including without limitation any and all claims for intellectual property infringement, physical or emotional injury or distress, defamation, or violation of any right of publicity or privacy.

This Release shall also inure to the benefit of heirs, legal representatives, agents, licensees, successors, and assigns of the Photographer, as well as the person(s) for whom the Photographer took the Pictures. I am a legally competent adult and have the right to contract in my own name. I have read this document and fully understand its contents. If the Pictures are of a minor, I am the parent or legal guardian of the minor and do hereby give my consent to this Release on behalf of the minor. This Release shall be binding upon my heirs, executors, legal representatives, and assigns.

This Release may be electronically signed, and I agree that if this document is executed electronically, that the electronic signature appearing on this Release is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility. I agree that my signature is an electronic representation of my signature for all purposes described in the Release and that I am agreeing to the terms of the Release with The University of Connecticut Foundation, Incorporated, the University of Connecticut, the State of Connecticut, and their respective agents, representatives, licensees, successors, and assigns.

Questions? Contact Lauren Jesmer, Assistant Director of Stewardship Impact Reporting, at 860.786.5174 or via email ([email protected]).

Review the terms and conditions.

This form collects the above information so that our team can communicate with you and provide assistance. Please check our Privacy Policy to see how we protect and manage your submitted data.