Student Stories Together

Student Stories Together

Student Stories Together collects and preserves personal narratives submitted by students for educational, archival, and promotional uses by the program. The undersigned provides the information and makes the representations, grants the rights, and accepts the terms set forth in this consent and release.

Student Information

Date of Birth:    Student ID:

Parent / Guardian (if student is a minor)

Student is under age 18:    If checked, the signature provided must be by a parent or legal guardian who represents authority to sign.

Story Submission

Written (essay, memoir)    Audio recording    Video recording    Photographic submission

Does the story contain material that may be sensitive (e.g., personal trauma, medical issues)? Yes No

Permissions and Release

By checking the boxes below and signing, the signer grants the rights and agrees to the terms set forth. The signer acknowledges that the Story may be used by Student Stories Together for educational, promotional, archival, and outreach purposes, and that such uses may occur in perpetuity.

Publication permissions (check all that apply):
Permission to publish in print materials
Permission to publish electronically and on program-managed digital platforms
Permission to use excerpts or images for social media and outreach
Permission to use for internal educational purposes only (no external distribution)

Name and attribution preference (check one):
Use full name as provided
Use first name only
Anonymous (do not attribute)

I hereby grant Student Stories Together and its agents, licensees, successors and assigns a non-exclusive, worldwide, royalty-free, perpetual license to reproduce, distribute, display, perform, adapt, edit, translate, and otherwise use the Story and any accompanying material or likeness in all media now known or later developed for program-related purposes. I acknowledge that the program may edit or excerpt the Story for clarity, length, or format and waive any right to inspect or approve such edits to the extent permitted by law.

I warrant that the Story is my original work (or that I have obtained all necessary permissions from co-authors, contributors, and third parties), that it does not violate any privacy, publicity, intellectual property, contractual, or other rights of any person or entity, and that no third-party approval is required for the rights granted herein. I agree to indemnify and hold harmless Student Stories Together and its representatives from any claims, losses, or liabilities arising from a breach of these warranties.

I understand and agree that I will not receive monetary compensation for the use of the Story unless a separate written agreement is executed. I further understand that I may request withdrawal of this consent in writing, but that withdrawal will not affect uses already made in reliance on this consent prior to receipt of the request and that copies previously distributed may remain in public archives.

Privacy and Records

Student Stories Together will retain submitted materials consistent with program needs and applicable law. The program will take reasonable steps to protect personal information but cannot guarantee absolute confidentiality when material is published. Requests to restrict use or to remove personally identifying information should be submitted in writing using the contact information provided below.

Acknowledgments

By signing below, the signer acknowledges that they have read and understand this Consent and Release, that they have authority to grant the rights indicated, and that they accept the representations, warranties, and release obligations contained herein.

I confirm that the statements in this form are true and accurate to the best of my knowledge, and I understand that false statements may subject me to program disciplinary procedures or other remedies permitted by law.

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