Global Educator Interview Publication Consent Form
Please complete this form to provide your consent for the publication of your interview as a global educator.
Educator Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Institution/Organization Name
*
Interview Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
I hereby grant permission for my interview as a global educator to be published in print, online, or other media formats. I understand that my responses may be edited for clarity or length and that my name and affiliation may be used in connection with the publication. I acknowledge that I have read and understood the information provided and consent to the publication as described above.
Additional Comments or Special Instructions (optional)
Signature
*
Submit Consent
Submit Consent
Should be Empty: