Student Media Application Form 2019-2020
Thank you in advance for taking the time to complete this form. Your application will help us identify the appropriate staff to contact you about your interest to ensure you have a positive experience with Student Media. If you have any questions about the form, please call our main office line at (703) 993-9745 or email
What is your legal name? (First and Last)
What is your Mason email address?
What is the best phone number to reach you at?
With which gender do you identify?
Prefer not to say
What is your major?
What is your current class standing?
Other (Extended Studies, Exhange Student, Non-Degree Seeking)
Where are you currently living?
Are you already involved with Student Media? (If involved and applying for a different position, please select 'No')
Please list your involvement with any other on-campus Mason offices or organizations (i.e., jobs, clubs sports, student orgs). If none, leave blank.
Please list your past co-curricular activities with Student Media:
Communication 145 / 345 - Newspaper Workshop
Communication 148 / 348 - Radio Workshop
Communication 347 - Cable TV Programming and Marketing
Literary Submission (George Mason Review, Hispanic Culture Review, Phoebe, So to Speak, Volition)
Consent to Release Student Information
With my electronic signature below, I authorize release of my academic records to the Student Media directors, advisers,and media group leaders and, if selected, allow the directors, advisers, and media group leaders to discuss my Student Media co-curricular experience.
Please electronically sign your Full Legal Name understanding that you agree to the Consent to Release Student Information
Please select today's date to validate your electronic signature
Student Media Copyright Policy
George Mason University Student Media (Mason-SM) is an unincorporated association of students at George Mason University. You (the Creator), is an individual seeking to contribute creative work product to George Mason University Student Media. Mason-SM and Creator, and their parent or guardian if Creator is a minor, agree to the following license governing the Creator’s contributions to Mason-SM (the Works):
COMPLETE WORKS: (Creator retains content ownership and grants Mason-SM a license) This copyright agreement grants Mason-SM and its constituent entities a non-exclusive, unrestricted, royalty-free, irrevocable, worldwide license of copyrights to prepare, transmit, edit, adapt, distribute, display, perform, publish, and reproduce the Works in whole or in part (including derivative works) in any medium (print, electronic, or formats yet unknown) for any purpose in perpetuity. Mason-SM will only sublicense work to a non-GMU entity with written consent from the Creator. Any individual work contributed to Mason-SM by the Creator is not considered a work made for hire and is the sole property of the Creator.
COLLABORATIVE WORKS: (Publisher retains content ownership and grants the Creator a license) This copyright agreement grants Mason-SM full ownership and copyright of the Works and grants the Creator a limited copyright license. This copyright agreement grants the Creator the right to display, reproduce, and distribute the Works in Creator's portfolio, job/internship applications, clip file, awards entries, personal websites, and third party trade publications or exhibits for the purpose of promoting or exemplifying the Creator's work. The Creator may only sell or receive compensation for the Works upon written consent of Mason-SM.
By signing this agreement, the Creator certifies that they are the sole creator/owner of the Works and have full power and legal authority to grant a copyright license to Mason-SM for the purposes outlined above. If the Works contain excerpts from other copyrighted material, the Creator has acquired in writing any and all necessary rights and permissions from the third party creator/owner to include that material in the Works and have provided appropriate credit for said third party material. If the Creator has previously granted a copyright license for the Works to another person or entity, the Creator has received explicit, written permission from that licensee to republish the Works prior to submission to Mason-SM and will provide said permission upon request.
The Creator, and their parent or guardian if Creator is a minor, agrees that this license shall exist as long as the intellectual property is entitled to protection under the laws of the United States and cannot be revoked except with written consent from Mason-SM.
By signing this copyright agreement, the Creator indemnifies and holds harmless George Mason University, its employees and agents for any and all claims related to the use, publication, and distribution of the Works.
Absent a signed physical copy of this release, the Creator agrees that electronic submission of this form constitutes a digital signature and suffices as a signed release.
By signing you also give consent for Student Media to share your contact information with other members of the Mason community for the purposes related to your participation in Student Media.
Please electronically sign your Full Legal Name understanding that you agree to the Student Media Copyright Policy
Please select today's date to validate your electronic signature.
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