Consent to Publish

The Faculty of Public and Global Affairs (FPGA) requests to publish your name, image (photo or video), biography, scholarship award details, and/or other information to be published for the purposes of promotion or publicity as described in the form below.

Date(Required)

MM slash DD slash YYYY

Name(Required)

First Last

Carleton Email(Required)

Please indicate whether you are:(Required)

Student

Staff

Faculty

Please indicate the type(s) of production you are participating in:(Required)

Photography

Video

Podcast

Please select all that apply.

Please indicate how FPGA can use your image and/or information:

On FPGA’s websites

On FPGA’s social media

On Carleton University’s website(s)

On Carleton University’s social media

For use in promotional material (posters, signage, brochures, etc.)

Please provide a brief description of the promotion or publicity that you consent to participate in:(Required)

The time period of permission granted is five years. If you would like to indicate another time period, please do so below:

No time limit

Other

The personal information requested on this form is collected under the authority of the Carleton University Act in accordance with Section 38(2) and 42(1) of the Freedom of Information and Protection of Privacy Act (FIPPA). The information provided will not be used for any purposes other than those stated upon this form unless you consent otherwise. Carleton University is fully compliant with FIPPA and endeavours at all times to treat your personal information in accordance with this law. Should you have any questions concerning your personal information, please contact:

Consent

By selecting the checkbox and providing my Carleton e-mail address as a signature, I understand that my personal information and image may be published in hard copy or online and I hereby provide explicit consent to publish the information detailed in this form. This information will be retained and disposed of in accordance with approved records retention and disposal schedules of the University.

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