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Photo Release Agreement

By submitting this photo release form, you are granting Keene State College permission to use photographs of you, taken through the College Relations Office, to be used for student recruitment or fund-raising purposes.

If you have any questions, please contact Chris Justice at 603-358-2121.

*
All fields marked with an * are required.
* First Name



   Middle Name



* Last Name



* Campus/Local/Cell Phone Number
Example: 603-555-1234



* Hometown



* Home State (abbreviation)
Examples: NH, VT, CT



* Class Year
Example: 2007



   If living on-campus,
which residence hall?




* Your declared or likely major



   What do you like about your major?



   Do you consider any particular faculty or staff member a mentor? If so, please explain



   Favorite class (or professor)



   Favorite web site?




   Co-curricular activities
(varsity or club sports, student organization,
residence hall council, music, theatre, other)




   Things you do with your friends



   Favorite book



   Favorite film



   Favorite musician/musical group



   The one thing you're proudest of



   Have you participated in a National or International Exchange program?
If so, please explain




   Are you a KSC scholarship or grant recipient?
Please explain




   Why did you pick KSC?



   Tell us why you would recommend Keene State to a friend?



   What are your personal and career goals?



   How has KSC changed you?



   What did you write your application essay about?



   Have you held an internship or participated in the Academic Excellence Conference, an independent study, or special project/research working closely with a faculty member?
If so, please explain




   If yes above, who was your faculty sponsor?



*

By submitting this online photo release, I understand that I am granting Keene State College permission to use photographs of me, taken through the College Relations Office, to be used for student recruitment or fund-raising purposes.


If you have any questions, please contact Chris Justice at 603-358-2121.



Updated: December 7, 2006

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