Permission form

Institution name

…………………………………………………………………………………

Department name:

…………………………………………………………………………………

Per...
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Viewpoints for flexible curricula - permission form

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Viewpoints for flexible curricula - permission form

  1. 1. Permission form Institution name ………………………………………………………………………………… Department name: ………………………………………………………………………………… Permission form – use of photographs, audio or video FORM FOR INDIVIDUAL CONSENT I consent to the use of photographs/video/audio of myself, (delete as appropriate) taken by members of the programme design team on behalf of the institution, bring used internally and for educational dissemination. These images/video/audio are for use for the following purpose(s): Purpose(s) To aid curriculum planning ………………………………………………………………………………… (insert purpose here) ………………………………………………………………………………… (insert purpose here) ………………………………………………………………………………… Agree Do not agree PRINT INDIVIDUAL’s NAME: …………………………………………………………………………………………..................... SIGNATURE:…………………………………………………………………………………. DATE:………………………………………. EMAIL: ……………………………………………………………………………………………………………………………………………… DEPARTMENT/PROGRAMME (if applicable):……………………………………………………………………………………..

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