MARICOPA COUNTY COMMUNITY COLLEGE DISTRICT

2411 West 14th Street, Tempe, AZ 85281-6942

PERMISSION TO USE PHOTOGRAPH & QUOTE

I authorize the Maricopa Community Colleges (including its colleges and related entities) to use photographs or videos of me and the quote from me indicated below for educational or promotional purposes in any type of media, including its website. The photographs, videos or the quote may not be used for profit without my express permission. I understand that I will not be paid or rewarded for providing this authorization.

The quote to be used is the following:

Signature: ___________________________________

Printed Name: _________________________________

Date: ________________________________________

Parent’s Signature: _____________________________

MC-PUPQ (04/01/10) Page 1 of 1

MARICOPA COUNTY COMMUNITY COLLEGE DISTRICT

2411 West 14th Street, Tempe, AZ 85281-6942

PERMISSION TO USE PHOTOGRAPH & QUOTE

I authorize the Maricopa Community Colleges (including its colleges and related entities) to use photographs or videos of me and the quote from me indicated below for educational or promotional purposes in any type of media, including its website. The photographs, videos or the quote may not be used for profit without my express permission. I understand that I will not be paid or rewarded for providing this authorization.

The quote to be used is the following:

Signature: ___________________________________

Printed Name: _________________________________

Date: ________________________________________

Parent’s Signature: _____________________________

MC-PUPQ (04/01/10) Page 1 of 1