Profile and Media Release Form

If you are enthusiastic about your Fort Valley State University experience and want to be considered for participation in an upcoming photo or video shoot, then we want to hear from you. Students who are full-time, degree-seeking students are welcome! Please complete the following form and upload a candid photo.

Selection will be influenced by the university’s diverse marketing needs. Individuals will be contacted when photo opportunities arise.

Profile and Media Release Form

  • Gender:
  • Ethnicity:
  • Status: * Required
  • Help us get to know you better. What are your future aspirations? Who's your role model? Etc...
  • Terms and Conditions * Required
    If chosen as a Fort Valley State University model with regards to any photography/videotaping/audio recording session (the "Session") in which I participate in, I hereby give to Fort Valley State University (“FVSU”) my permission to photograph, record, videotape, audiotape or otherwise produce and reproduce the Session, and without limitation, my voice, image or likeness and/or use my name in any and all manner and media formats now in existence or later created (collectively the “Recordings”), including, by way of example, but not limitation, print, film, iTunes, YouTube, Facebook, audiotape, videotape, CD, DVD, television, radio, webcasts and podcasts throughout the world in perpetuity for any lawful purposes, including, but not limited to archival, teaching, research, public service, publicity and institutional promotional campaigns, without any obligation to provide payment or royalties. I understand and acknowledge that FVSU owns the copyright in the Recordings, and the Recordings may be edited in FVSU’s sole discretion. Further, I release Fort Valley State University, its agents, employees, licensees, and assigns from and against any and all claims or any other causes of action arising out of production, distribution broadcast or exhibition of the work in any medium, including but not limited to the media listed above.
  • This field is for validation purposes and should be left unchanged.