CONSENT AND RELEASE FORM

CONSENT AND RELEASE FORM
Please check all applicable:
____ Name and Quotes
____ Published Writings
____ Unpublished Manuscript
____ Graphic or Digital Images
____ Original Art
____ Videotape
____ Audiotape
____ Film
____ Websites
____ Other: _________________________
Name (please print)
Student ID Number
Address
City/State/Zip
Day and Evening Phone
Email Address
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
I HEREBY GIVE MY CONSENT FOR Metropolitan Community College or its agency to use my
name, likeness, photograph and/or comments. I understand these will be used exclusively for the
College without compensation, be it publications, advertising, television, film, radio, Internet or
other appropriate communication or educational media.
I sign this of my own free will.
Signature _____________________________________________ Date ___________________

esource.mccneb.edu/metropolitan
The Metropolitan, MCC’s student writing magazine,
publishes all types of academic and literary writing,
including descriptive, narrative, expository, and
persuasive works, as well as creative prose and poetry.
Publish Your Writing
To submit your work, fill out the consent form on the back of this
flyer. Send or deliver this form and a CD copy of your work to
The Metropolitan
c/o Cindy Catherwood
CON 233, South Omaha Campus
Metropolitan Community College
P.O. Box 3777
Omaha, Nebraska 68103-0777
or
to any MCC Writing Center. You can also submit your work
electronically to metropolitan@mccneb.edu
For submission help or other questions,
see our website, find us on Facebook, or call 738-4683