Education Platform Testimonial Release Form
Submit your testimonial and grant permission for its use by the education platform.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to the Education Platform
*
Student
Parent/Guardian
Educator/Instructor
Alumni
Other
Program or Course Name
*
Years Attended or Involved
May we display your testimonial with your name?
*
Yes, you may use my name with my testimonial.
No, please keep my testimonial anonymous.
Your Testimonial (Please share your experience, feedback, or story)
*
Upload a photo or video (optional)
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Signature (Please sign below to confirm your release and consent)
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Date of Submission
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Month
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Day
Year
Date
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