Submitted by Emily Rebecca V... on Thu, 05/18/2017 - 17:05 As a condition of being a student at Stanford, the University may photograph you in public areas and use those images to support its educational mission. In addition, the Program in Science, Technology, and Society (STS) seeks your consent to use the items identified below for use of publications, on websites, and on displays in public areas for official use by STS. In order to revoke this authorization, you must notify STS in writing. This form will be kept on file at the STS office. Authorization * I authorize use of the following for the purpose identified below: my image, name, quotes or other text, and recordings (e.g., audio, visual) that I have provided to the STS Program upon request. I do not authorize the use of my image, name, quotes, or other text, or recordings for any purposes identified below: On STS websites In STS printed publications (e.g., fliers, posters, etc.) that may be distributed within the STS Program or to the broader University In STS printed publications (e.g., fliers, posters, etc.) that may be distributed to the general public On STS photo boards or other displays in public areas Student Name * Stanford ID Number * Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2018201920202021 Important Note re Student Athletes Student-athlete names or images may be used by the department/program in their own local displays and publicity materials. Student-athlete names or images may NOT be included on any flyer or other publicity materials that include a non-Stanford logo or brand as this creates a NCAA issue. Example: A flyer produced for an upcoming major recruitment event cannot include the name or image of a student-athlere if it also includes a logo for a sponsoring business or a guest speaker. This would result in an NCAA compliance issue and possibly result in the athlete being declared as ineligible to compete. This type of conflict may occur when an event is co-sponsored by a local company or retailer. Departments/Programs shouls always consult with the Assistant Athletic Director for Compliance Services for permission to include the name and/or image of a student-athlete in any type or advertisement.