Media Release Agreement

TEMPLATE 201.5

Media Release Agreement

Instructions for researchers - This template is for publication, broadcast or distribution of identifiable information that is expected to be circulated publically (i.e., internet sites, promotional materials, books, articles, etc.). Different from the Invitation & Consent Agreement (TEMPLATE 201.3), theMedia Release Agreement reflects the needs of publishers or partners. Check with the publishers or partners to ensure that the wording is appropriate for their needs. Their logo can be included in the header or footer, if appropriate. If you choose to follow this template closely, replace the RED text with details specific to your project.

Media Release Agreement

Date:[Insert Date]

Project Title:[Insert Title]

Principal Investigator:
[Insert name, status/role e.g. professor, faculty supervisor]
Faculty of [Insert Dept Name]
Emily Carr University of Art and Design
[Phone number and extension; email address] / Other Researchers:
[Insert names, status/role e.g. student, graduate student, faculty member]
Faculty of [Insert Dept Name]
Emily Carr University of Art and Design
[Phone number and extension; email address]*

[*NOTE: Instead of providing their personal email addresses and phone numbers, students are encouraged to make use of a university email alias for circulation to research participants. Supervisors can request an email alias from IT Help.]

PROJECT DESCRIPTION

The purpose of the [insert title] research study is [insert purpose statement and brief project description.] In the process of this study, identifiable material will be collected by way of [describe: video or audio recordings or photographs, of you or your property]. The purposes of collecting this material include [describe in as much detail as possible the expected uses of the identifiable materials such as specific publications or presentations or websites.]

COMMERCIAL INTERESTS & PARTNERSHIPS [If applicable]

The following project partners will have access to [describe: video or audio recordings or photographs, of you or your property] for the purpose of [describe in as much detail as possible the expected uses of the identifiable materials]

RELEASE STATEMENT

I agree to allow the following identifiable materials to be used in the publication of the research described above

Check all that apply [modify as appropriate]:

DIRECT QUOTATIONS -

Yes, I consent to being quoted in publications.

No, I do not consent to being quoted in publications.

INDENTIFICATION -

Yes, I consent to the inclusion of my identity (name) in publications.

No, I do not consent to the inclusion of my identity (name) in publications.

IMAGES AND RECORDINGS OF ME OR OF MY PROPERTY -

Yes, I consent to the use of digital images (photos or video) or audio recordings taken during the research to be used for publication purposes.

No, I do not consent to the digital images (photos or videos) or audio recordings taken during the research to be used for publication purposes.

Or,

Yes, I consent to my photo being converted to a line drawing, with all personal identifiers removed, as seen in the example provided below.

No, I do not consent to my photo being converted to a line drawing, with all personal identifiers removed, as seen in the example provided below.

I agree to the release of identifiable materials as described above for the publications described above. I have made this decision based on the information I have read here[and list any other consent materials that you make available to the participants]

Name:______Date:______

Signature:______

Witness Name:______Date:______

Signature:______

Thank you for your assistance in this project. [The researcher must provide two copies for signing. One copy is retained by the consenting participant.]