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AUTHORIZATION FOR USE OF IMAGE, VOICE, PERFORMANCE, ARTWORK OR LIKENESS
I permit and authorize the University of Houston (the University - a component institution of the University of Houston System) and its employees, agents, representatives, contractors, and personnel who are acting on behalf of the University to create and/or obtain and use my photograph, my voice or quotes/excerpts of my written or verbally expressed words, my artwork or a photograph of my artwork, my name, alias, or biographical information, a video and/or audio recording or other likeness of myself (hereinafter collectively referred to as My Likeness) for purposes related to the educational mission of the University, including instructional and/or educational purposes, publicity, marketing, and promotion of the University and its various programs without compensation to me. I understand My Likeness may be copied/reproduced and distributed by means of various media, including, but not limited to, video presentations, simultaneous television broadcast/rebroadcast, radio transmission/retransmission, news releases, mail-outs, e-mails, billboards, signs, brochures, placement on websites and/or other electronic delivery, publication, display, or promotion on any and all other media, and I further understand that My Likeness may be subject to reasonable modification or editing. I acknowledge that the University has the right to make one or more photographs, audio recordings, videotape or disk presentations, or other electronic reproductions of My Likeness in accordance with this Authorization for Use of Image, Voice, Performance, Artwork, or Likeness (hereinafter sometimes referred to simply as this Authorization). I waive any right to inspect or approve the finished product or material in which the University may eventually use My Likeness.
I relinquish and give the University all rights, title and interests in and to My Likeness, including any copyright therein. This Authorization shall be binding upon my heirs, successors, assigns, and legal representations.
I understand that, although the University will endeavor to use My Likeness in accordance with standards of good judgment, the University cannot warrant or guarantee that any further dissemination of My Likeness will be subject to University supervision or control. Accordingly, I release the University from any and all liability related to the dissemination, reproduction, distribution, and/or display of My Likeness in print or any and all other media, and any alteration, distortion or illusionary effect of My Likeness, whether intentional or otherwise, in connection with said use. I also understand that I may not withdraw my permission for use of My Likeness which was granted in this Authorization.
By submitting this application, I acknowledge that I have read and understand the conditions of this Authorization for Use of Image, Voice, Performance, Artwork, or Likeness.
AUTHORIZATION TO RELEASE EDUCATIONAL RECORDS
Family Educational Rights and Privacy Act of 1974 as Amended (FERPA)
I certify that the information contained in this application is correct and true. I authorize UH and the Office of Undergraduate Research to verify any information relevant to my application for the Provost's Undergraduate Research Scholarship at the University of Houston or any claims made herein. I further agree to release any information concerning my records at the University of Houston to CMC for the administration of the PURS program.
I hereby agree that should I receive a Provost's Undergraduate Research Scholarship, I will agree to fulfill the terms of the program, which includes conducting 100 hours of research per semester under the supervision of a faculty mentor, attending the PURS spring 2017 kickoff event, submitting a reflection piece on my PURS experience, and completing the online survey at the end of the semester assessing my experience conducting research.