UConn School of Nursing
News Release
Please fill out the information as completely as possible.  Items marked with an asterisk (*) indicates a response is required.

Personal Information


Media Contacts:

Please list the media sources (journals, newspapers, associations, etc.) you would like to receive the news release.  Please provide contact/address if known.

Important Past/Current Experience:

Statement of Release:

I give permission for the School of Nursing and the University of Connecticut to use, re-use, publish and re-publish the same in whole or in part, individually or in conjunction with other mediums, now known or hereafter devised for any purpose whatsoever, including, but not by way of limitation, illustration, promotion, advertising and trade, and to use my information such as name, anticipated graduation date, program of study or degree, professional title, research topics, etc. in connection there with if it so chooses.

I give up any right I may have to inspect and approve the finished products or advertisements in which the information may be used. I hereby release and discharge the School of Nursing and the University of Connecticut, and its employees, successors, assigns, and designees from any and all claims and demands arising out of or in connection with the use of such information including but not limited to any claims for defamation or invasion of privacy.

I understand the contents of this and have the authority to grant the rights given in this release. *
Powered byFormsiteReport abuse