The Graduate Support Programs office publishes profiles of outstanding scholars at ASU; as well as highlights outstanding research and accomplishments on the website, social media, in printed materials and/or news releases.
Please complete sections of this form that pertain to you and send it along with a photo of yourself to gradinfo@asu.edu
. The photo needs to be sharp and clear, preferably taken at medium to high quality with a digital camera. Head shots are preferred and it should be of you alone with no other people in the photo. If you would prefer to have your photo taken by a Graduate Education staff member, please contact gradinfo@asu.edu
to make arrangements. Prior to posting or publishing any of your information we will contact you to review your profile for accuracy.
MIDDLE NAME LAST NAME
ASU AFFILIATE ID#
COLLEGE
FIRST NAME
EMAIL
PROGRAM
PHONE
DEGREE
Master
’s
PhD
I am affiliated with (check as many as apply):
ASU IGERT Program ( enter name of IGERT program )
ASU Postdoctoral Scholar
Graduate Education Fellowship ( enter name of fellowship )
Graduate Education Professional Development Programs ( enter program name )
Shades Multicultural Mentoring Program
Other
Please give a brief synopsis of your research/studies:
Name one or two ways in which you hope that your research will positively impact society:
Why did you decide to earn your graduate degree at ASU?
WHAT IS YOUR CAREER GOAL?
PROJECTED GRADUATION DATE TITLE OF THESIS OR DISSERTATION
PUBLICATIONS, HONORS, RECOGNITIONS OR AWARDS
DEGREE
DEGREE
YEAR
YEAR
TITLE OF THESIS OR DISSERTATION
TITLE OF THESIS OR DISSERTATION
UNIVERSITY
UNIVERSITY
PUBLICATIONS, HONORS, RECOGNITIONS OR AWARDS
CURRENT PLACE OF EMPLOYMENT
JOB TITLE
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CITY STATE
10-27-14

I grant permission to the Arizona Board of Regents, on behalf of Arizona State University and its agents or employees, to copyright and publish all or any part of photographs and/or motion pictures and/or voice recordings and/or written/spoken statements taken of me for use in university publications, including printed, moving, audio and electronic, all exhibitions, public displays, publications, commercial art, and advertising purposes in any media without limitation or reservation. I hereby waive any right to inspect or approve the finished photographs/motion pictures/voice recordings/ written/spoken statements or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs/motion pictures/voice recordings/ written/spoken statements.
I hereby agree to release, defend, and hold harmless the Arizona Board of Regents, on behalf of Arizona State University and its agents or employees, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper, in motion pictures, or via electronic media, from and against any claims, damages or liability arising from or related to the use of the photographs/motion pictures/voice recordings/written/ spoken statements, including but not limited to any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. It is the discretion of Arizona State
University to decide whether to use the image.
I agree that any photographs taken by me and submitted by me to the Graduate Education office will not be copyrighted by ASU, but
ASU will retain all usage rights as listed above.
I am 18 years of age or older, and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing before signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
By typing my name below (or inserting my electronic signature), I verify that I have read and agree to the terms outlined in
Section IV.
SIGNATURE: DATE:
Email: Save this file with your name as the file name and send as an attachment to gradinfo@asu.edu
Fax: 480-965-0375 Walk: Graduate Support Programs
Interdisciplinary Building B
Suite 285
Call: 480-727-7627
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