Media Authorization Form

Clarkson College wants to celebrate your achievements. When you're nearing graduation or receive an award such as a scholarship or dean's list recognition, we can send a media release to your hometown newspapers announcing your achievement. Completing and submitting this form authorizes your information to be released to the media. It also authorizes that Clarkson College has permission to take photographs, audio and video in which you may be included for public use.

To update permissions and information used in these media releases, please enter your student ID and last name below.

If your last name has changed please enter the name that is currently on official file with Clarkson College. If you are still having issues please e-mail webmaster@clarksoncollege.edu.

Student ID:
Last Name:
 

If your last name has changed please enter the name that is currently on official file with Clarkson College. If you are still having issues please e-mail webmaster@clarksoncollege.edu.

Verify your name and contact information. Please note: Your student ID, email address and phone number will not be shared in your media release.

First Name:
Middle Initial:
Last Name: To change your name, please complete the Official Name Change Form.


Student ID:
E-mail:
Primary Phone Number:
If Clarkson College needs further information for this form, we will contact you at this number. Editing this number will not change the phone number the Registrar's office keeps on-file.


Required Media Release Information

Please complete or edit your education information, along with your hometown where the media release will be distributed.

Degree:
Health Care Business Minor:
Program(s) of Study:
* Home State:
* Hometown:
* Hometown Newspaper:


Optional Media Release Information

Tell us about your honors, activities and scholarships.

Honors & Activities:


Scholarships:


If a graduate student, please share your thesis title:

Student's Current Employer:
Employer City, State & ZIP:

High School Attended:
High School Graduation Year:


Parental Information
If parents are separated, please list names individually:
Parent(s) Name:
City, State & ZIP:
 
Parent(s) Name:
City, State & ZIP:
 
Parent(s) Name:
City, State & ZIP:
 
Parent(s) Name:
City, State & ZIP:  

By submitting this information, you voluntarily authorize Clarkson College and its employees/agents to take photographs and produce newspaper articles, magazine articles, video and/or audio recordings in which you may be included and connected in whole or in part to Clarkson College.

Clarkson College makes every effort to send announcements regarding graduation, dean's list recipients and scholarship awards to the appropriate media. It is at the discretion of the individual media outlet if they choose to publish the information. If you have any questions, please contact the Clarkson College Marketing department.




An error has occured. Please make sure that you have filled in all the required fields.
If you are still having issues please email webmaster@clarksoncollege.edu.

Your media release information has been successfully updated. Thank you!