HOUSTON INDEPENDENT SCHOOL DISTRICT
WEST UNIVERSITY ELEMENTARY SCHOOL
Texas Education Agency Exemplary School
Texas Business & Education Coalition Honor Roll School
Texas Monthly Best Public School in Texas
3756 UNIVERSITY BLVD. HOUSTON, TX 77005-2898
TEL (713) 295-5215 - FAX (713) 667-8514
John T. Threet, Principal
HOUSTON INDEPENDENT SCHOOL DISTRICT
STUDENT MEDIA RELEASE FORM
West University Elementary School is frequently asked to participate in media events. Many
times we are given short notice of media visits to the school. As a result, we are requesting
permission in advance for your child to appear in any screened media events that may occur this
school year including, but not limited to, television, radio, and newspapers. All media events are
approved by the HISD Press Office and our school principal. You may withdraw your
permission for your child to participate in media coverage at any time by notifying us in writing.
____I grant permission to the Houston Independent School District and West University
Elementary School to use the media (television, radio, and/or newspaper) on which
appears.
my child
(print child’s name)
____I do not grant permission for my child
to
(print child’s name)
participate in any media event.
___________________________________________
Printed name of parent/guardian
___________________________________________
Signature of parent/guardian
___________________________________________
Address
___________________________________________
Date
PLEASE COMPLETE AND RETURN TO YOUR CHILD’S TEACHER
Creating a College-Bound Culture
It is the policy of the Houston Independent School District not to discriminate on the basis of age, color, handicap or disability, ancestry, national
origin, marital status, race, religion, sex, veteran status, or political affiliation in its educational or employment programs and activities.