Educational Video Licensing Consent Form
Please complete this form to provide your consent for the use and licensing of your educational video content.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Video Title or Description
*
Purpose of Video Use
*
Educational (Classroom Use)
Online Publication (Website/YouTube)
Conference/Workshop Presentation
Other
Signature (Please sign below to confirm your consent)
*
Date of Consent
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
Should be Empty: