Utah Valley State College
Multimedia/Internet/Writing Release Form

for Lee Ann Mortensen, MFA

Please PRINT this out, then sign it and attach it to a digitized copy of your work (on disk or as an E. Mail attachment in either Word Perfect 8 or lower or Microsoft Word 6 or lower!!!!).  Then give it to your instructor.

Name: _______________________________________

Address: ___________________________________________________________



Phone Number: ______________________________________________________

Name of the Work(s) or Likeness You are Releasing: _____________________________________


I, ____________________________ , do hereby give permission to Utah Valley State College and/or Lee Ann Mortensen, and any of their representatives, to use my work and/or likeness in any and all photographs, video footage, sound recordings, and any other media that might be used for the CD-ROM College English: A Self-Paced, Multimedia Approach, and/or on the English 1010 or 1020 Web page (or any equivalent course number), and/or for the English 2250 or 225H or 2420 Web page (or any other creative writing course), and for any future revisions, extensions, or modifications of these products.  If I am submitting work, I also give Lee Ann Mortensen permission to freely use my work to help all her other students learn more about writing, thinking, reading, research, and creativity.

I am aware that the use of my work or likeness does not bar me from submitting or using my work or likeness anywhere else or to anyone else for any other purpose.

I hereby waive claim to any rights, residuals, fees, or any other form of remuneration or compensation which are not specifically set forth herein.


Signature of Talent ______________________________           Date _____________________


Signature of UVSC or Lee Ann Mortensen Representative ______________________________

Date ______________________

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