Photo/Film Authorization

fans - university of minnesota duluth

Authorization for Photography, Filming, or Interviewing

Consent Form PDF

Please print
Name _____________________________________________________
Address ___________________________________________________
Home Phone __________________ Work Phone ___________________
Email Address (optional) ______________________________________

____ (initial) I hereby expressly grant the University of Minnesota the right to make, use and/or publish information, photographs, or any other reproduction of my physical likeness for various communication efforts such as pamphlets, booklets, video tapes, audiotapes, slide shows or internet sites. In addition, I expressly grant this right to be use for educational, marketing, and/or promotional information.

____ (initial) I hereby expressly grant consent to be photographed, filmed and/or interviewed by:

Name _______________________________________________________
Department, address, phone, email address _________________________
____________________________________________________________
Purpose ______________________________________________________

____ (initial) The University of Minnesota may use resulting media coverage in its internal or external promotional activities.
____ (initial) I understand that the University of Minnesota shall not be responsible for media’s use of any films, photographs or interviews.

Signature __________________________________________ Date _______
Parent/Guardian’s Signature (if under 18) ________________ Date _______
Witnessed (name & title): ______________________________ Date _______

The University of Minnesota is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race, color, creed, religion, national origin, sex, age, marital status, disability, public assistance status, veteran status, or sexual orientation.

The University of Minnesota, founded in the belief that all people are enriched by understanding, is dedicated to the advancement of learning and the search for truth; to the sharing of this knowledge through education for a diverse community; and to the application of this knowledge to benefit the people of the state, the nation, and the world. The University’s threefold mission of research and discovery, teaching and learning, and outreach and public service is carried out on multiple campuses and throughout the state.
____________________________________________________________

Department Use Only

Photo Description ______________________________________________
It is the responsibility of the photographer and/or recorder to retain authorization forms.

University of Minnesota Duluth | 1049 University Drive | Duluth, MN 55812 | www.d.umn.edu | 218-726-8000

Consent Form PDF

FILMING ON CAMPUS
For information on Filming on Campus see Publicizing Events at UMD

Office of External Affairs

University of Minnesota Duluth
1049 University Drive
302 DAdB
Duluth, MN 55812
218-726-6140
umdnews@d.umn.edu

Staff

Lynne Williams
Director of External Affairs
218-726-6141
lwilliam@d.umn.edu

Cheryl Reitan
Associate Director for External Affairs
218-726-8996
creitan@d.umn.edu

Betty Greene
Associate Administrator
218-726-6140
bgreene@d.umn.edu

Brett Groehler
Director of Photographic Services
218-726-7115
bgroehle@d.umn.edu

Charlene Aaseng
Graphic/Multimedia Designer
218-726-6858
caaseng@d.umn.edu

Kathleen McQuillan-Hofmann
Communication Associate
218-726-7111
kmcquill@d.umn.edu

Lori Melton
Communication Associate
218-726-8830
lmelton@d.umn.edu

Joel Youngblom
Web Development & Content Manager
218-726-8798
jyoungbl@d.umn.edu


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