First and Last Name
People Soft #
Cell Phone #
Does the number provided above recieve text messages?
Yes, it recieves text messages
No, it does not recieve text messages
Expected Graduation Year
What is your intended major? Put"undeclared" if still undecided.
What is your intended minor? Put"undeclared" if still undecided.
Current college grade point average. If none, put "N/A".
Please check your areas of interest.
You are not limited to one choice.
Audio/Visual Set Up
What type of original programming would you like to see and/or work on?
"Original Programming" is programming made by fellow SVN members. You are not limited to one choice.
How many hours a week will you be available for SVN?
This is only an estimate of how much time you would be able to contribute.
Do you live on campus?
If so, when do you usually watch TV?
You are not limited to one choice.
10am - 12pm
12pm - 2pm
2pm - 4pm
4pm - 6pm
6pm - 8pm
8pm - 10pm
After 10 pm
Would you be more inclined to watch SVN if there were televisions around campus?
Authorization for use of image, voice, performance, artwork, or likeness.
I permit and authorize the Student Video Network at the University of Houston - Main Campus (the “University” - a component institution of the University of Houston System) and its employees, agents, representatives, contractors, and personnel who are acting on behalf of the University to create and/or obtain and use my photograph, my voice or quotes/excerpts of my written or verbally expressed words, my artwork or a photograph of my artwork, my name, alias, or biographical information, a video and/or audio recording or other likeness of myself (hereinafter collectively referred to as “My Likeness”) for purposes related to the educational mission of the University, including instructional and/or educational purposes, publicity, marketing, and promotion of the University and its various programs without compensation to me. I understand My Likeness may be copied/reproduced and distributed by means of various media, including, but not limited to, video presentations, simultaneous television broadcast/rebroadcast, radio transmission/retransmission, news releases, mail-outs, e-mails, billboards, signs, brochures, placement on websites and/or other electronic delivery, publication, display, or promotion on any and all other media, and I further understand that My Likeness may be subject to reasonable modification or editing. I acknowledge that the University has the right to make one or more photographs, audio recordings, videotape or disk presentations, or other electronic reproductions of My Likeness in accordance with this Authorization for Use of Image, Voice, Performance, Artwork, or Likeness (hereinafter sometimes referred to simply as “this Authorization”). I waive any right to inspect or approve the finished product or material in which the University may eventually use My Likeness. I relinquish and give the University all rights, title and interests in and to My Likeness, including any copyright therein. This Authorization shall be binding upon my heirs, successors, assigns, and legal representations. I understand that, although the University will endeavor to use My Likeness in accordance with standards of good judgment, the University cannot warrant or guarantee that any further dissemination of My Likeness will be subject to University supervision or control. Accordingly, I release the University from any and all liability related to the dissemination, reproduction, distribution, and/or display of My Likeness in print or any and all other media, and any alteration, distortion or illusionary effect of My Likeness, whether intentional or otherwise, in connection with said use. I also understand that I may not withdraw my permission for use of My Likeness which was granted in this Authorization.
By agreeing to the terms above, you are also agreeing that all personal information is true and correct (Name, PeopleSoft#, etc.)
I have read and understand the conditions of this Authorization for Use of Image, Voice, Performance, Artwork, or Likeness.
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