Form No. OGC-S-2015-12
AUTHORIZATION FOR USE OF CREATIVE WORK OR COPYRIGHTED MATERIAL
(CENTER FOR STUDENT MEDIA)
I, (printed name) __________________________________________________ permit and authorize the University of Houston (the
“University”) and its employees, agents, representatives, contractors, and personnel who are acting on behalf of the
University
to
obtain
and
use
the
following
creative
work
or
copyrighted
material:
________________________________________________________________________, together with my written or verbally expressed
words, my artwork or a photograph of my artwork, a video and/or audio recording or other likeness of artwork, together
with my name, alias, or biographical information for identification and promotion purposes (hereinafter collectively
referred to as “My Work”) for purposes related to the educational mission of the University, including instructional and/or
educational purposes, publicity, marketing, and promotion of the University and its various programs without
compensation to me, my heirs, successors, assigns, and legal representatives. I understand My Work may be
copied/reproduced, sold and distributed by means of various media, including, but not limited to, video presentations,
simultaneous television broadcast/rebroadcast, radio transmission/retransmission, news releases, mail-outs, e-mails,
billboards, signs, brochures, placement on websites and/or other electronic delivery, publication, display, or promotion on
any and all other media, and I further understand that My Work may be subject to reasonable modification or editing. I
acknowledge that the University has the right to make one or more photographs, audio recordings, videotape or disk
presentations, or other electronic reproductions of My Work in accordance with this Authorization for Use of Creative
Work or Copyrighted Material (hereinafter referred to as “this Authorization”). I waive any right to inspect or approve the
finished product or material in which the University may eventually use My Work.
I hereby make the following representations and warranties regarding My Work: (1) that the sole ownership of all rights to
My Work vested in me or I have obtained and will deliver written authorizations for the use of any material owned by a
third party and included in My Work; (2) that I have full power to make this Authorization; (3) that the copyright to My
Work has not previously been assigned to another party; (4) that My Work does not infringe any valid copyright or other
proprietary or property right of any other party; and (5) that My Work contains no libelous, defamatory, or other unlawful
material.
I hereby license the University all rights, title and interests in and to usage of My Work, including any copyright therein.
Such license is non-exclusive and the University shall not pay any royalties or compensation to me, my heirs, successors,
assigns, and legal representatives for licensing My Work. This Authorization shall be binding upon my heirs, successors,
assigns, and legal representatives.
I understand that, although the University will endeavor to use My Work in accordance with standards of good judgment,
the University cannot warrant or guarantee that any further dissemination of My Work will be subject to University
supervision or control. Accordingly, I release and hold harmless the University from any and all liability related to
the dissemination, reproduction, distribution, sale, and/or display of My Work in any and all media (both current
and future), and any alteration, distortion or illusionary effect of My Work, whether intentional or otherwise, in
connection with said use. I also understand that the license provided herein is perpetual and I may not withdraw
my permission for use of My Work which was granted in this Authorization.
I have read, understand and agree to the conditions of this Authorization.
_______________________________
_____________/______________
_______________________________
____________________________
_______________________________
____________________________
Signature
Printed or typed name
Address
Date
Age (if minor)
Phone
City/State/Zip
CONSENT OF PARENT/LEGAL GUARDIAN REQUIRED IF ABOVE INDIVIDUAL IS A MINOR.
I am the parent and/or guardian of the above minor and hereby consent and agree to the foregoing terms and provisions
on his or her behalf.
________________________________
____________________________
________________________________
_____________________________
________________________________
_____________________________
Signature
Printed or Typed Name
Address
Date
Phone
City/State/Zip
Note: Modification of this Form requires approval of OGC
Office of the General Counsel
Authorization of Use of Creative Work or Copyrighted Material (Center for Student Media)
OGC-S-2015-12 Created 07.09.2015
Page 1 of 1
Standard Form Approved
by the University of Houston System
Office of the General Counsel
Office of Contract Compliance