Anderson Language and Technology Center
Student Media Project/ Video Release Form
The signature below indicates my permission for the University of Colorado to use my
final media project and/or on-camera interview for educational purposes only.
Project Name:
Term:
Course Name:
Instructor:
The final media project and/or interview may be used for the
following purposes:
 Conference presentations
 Educational presentations
 Instructor Multi-Media Portfolio
 Informational presentations
 Posted on an supported educational website for the promotion of assigning
student media projects.
The University will use my work in read-only form.
The University will credit any use of my work in the presentations listed above.
The University will provide that my work, in whole or in part, will not be used in a
way which will change the original meaning of my work.
I will be consulted and have prior right of approval about the use of media project
and/or interview for any purpose other than those listed above.
I agree that there is no geographic specification of where these materials may be
presented.
I understand and agree that I must comply with any and all applicable state and
federal laws, including copyright laws and restrictions, as well as any applicable
license agreements.
I assume responsibility for any actions on my part which may result in a claim against
the University or any other party related to University resources which I use on my
project, and I agree to indemnify and hold the University harmless from any such
claim. I understand that my failure to comply with these policies, laws and rules
may result in referral for potential disciplinary action.
I have been given a copy of this release for my records.
Name (Please print):
Signature:
Address:
Phone:
E-mail:
Date: / /