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Authorization of Media Release
Authorization of Media Release
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Student's Name
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First
Last
Student's Major
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Hometown Publications
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Exact name of scholarship being given:
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Name of organization granting:
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Dollar value of scholarship:
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How student was chosen:
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Date the award is valid (ex. 2021-2022):
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Student’s College Activities/Awards:
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Additional information:
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I consent to the release of information listed above for the purpose of publicizing the awarding of those funds. I will notify the Siena College Office of Communications and Public Affairs in writing should I not consent to the release of this information.
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I consent