Accounting Challenge

Student Information

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First Name

Last Name

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I am a:

Hidden: I am interested in SIU as a:

Current or most recent high school/college:

Hidden: CEEB Code

Primary Academic Interest

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Additional Information

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Student Level: Hidden

Accounting Challenge Media Release Form

I, the undersigned, hereby authorize Southern Illinois University to photograph me, take motion pictures of me, take video footage of me, and/or make electronic sound recording of me (herein referred to as photographic or electronic reproductions), during the above program dates.
I authorize the use of any such photographic or electronic reproductions of me for any purpose, including but not limited to, educational and other public media as may be deemed appropriate by Southern Illinois University during the above program dates.
I understand that I may be identifiable from such photographic or electronic reproductions produced during the course of the above program dates.

Student Consent
I do hereby agree to the media release terms and conditions, outlined above, associated with participating in the SIU Accounting Challenge during the program period outlined above.