Permission to Use Photos/Video

URL
This field is for validation purposes and should be left unchanged.
I grant permission to the Edward P. Fitts Department of Industrial and Systems Engineering (ISE) to use images of:
Name * Required
First Last
Permission Granted/Denied * Required
- I GRANT permission for the use of photos/videos of myself *
- I DENY permission for the use of photos/videos of myself *
Signature * Required
First Last
Date * Required
MM slash DD slash YYYY
Please notify ISE in writing if you would like to withdraw your permission for the use of images.
Are You a Robot? * Required
I am not a Robot