New Student

Name

Contact Info

About Yourself

YesNo

MaleFemale

YesNo

YesNo

$0 –$24000$25 –$49000$50 –$75000over $75000

YesNo

I hereby authorize Opportunity for Change (O F C), hereafter referred to as “Organization,” to publish testimonies and photographs taken of me and my name and likeness, for use in the Opportunity for Change (O F C) 's print, online and video-based marketing materials, as well as other publications within the organization. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs or participation in Opportunity for Change marketing materials or publications. I hereby release Opportunity for Change employees involved in the creation or publication of marketing materials, from liability for any claims by me.

YesNo