I understand that Austin Community College District (“ACC”) strives to use authentic images of
students and community members to promote the College and its programs. I wish to assist in
these efforts and hereby grant ACC the following permissions:

1. I permit ACC and its authorized agents to use, re-use, publish, and re-publish, in any
   medium, in whole or in part, without restriction as to changes or alterations, photographs,
   images, film or video footage of me, or other representations of my likeness in any medium
   whatsoever, individually or in groups in which I am included.
2. I permit ACC and its authorized agents to use my name and/or major.
3. I permit ACC to use written statements or quotes that I may provide to them about ACC and
   my experiences there.

In signing the Consent I understand and acknowledge that:

• My photograph, image, film or video footage of me or other representations of my likeness,
  as well as my name or statement may be used for ACC purposes in print publications, online
  publications, presentations, websites, social media, film, video, ACCTV broadcast, or other
  electronic communication productions for instructional, informational, promotional, or other
  purposes.
• I will not receive any remuneration for the use of my name, photograph, or quote, and understand
  that no royalty, fee or other compensation shall become payable to me by reason of such use.
• I release ACC District’s trustees, president, appropriate vice presidents and other administrators,
  faculty members, and staff from liability for any claim or course of action resulting from or in any
  way related to the use or publication of such photographs or statements.
• Said material is the sole property of ACC or its assignees. ACC will retain full copyright over the
  work that features the individual or talent.
• I have read this Consent in its entirety and understood it prior to executing it.
• EXCLUSIONS (please state specific exclusions where you will not release the use of your photo):