| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Beat the Odds
Your Information










Your Address




Your Race/Ethnicity - Check all that apply
Your Parent/Guardian Information





Household Information
No decimals or commas

Your High School Information




Academic Information
Experience and Honors



Recommendations

Recommender 1






Recommender 2





Upload Documents


Media Release and Authorization

I hereby authorize and irrevocable grant to the Children’s Defense Fund and its affiliates, licensees, agents, employees and assigns the unrestricted right to use and publish any part of the information I have provided to the Children’s Defense Fund and the rest to record my name, appearance, likeness, the sound of my voice and my comments on film, videotape, audiotape, still photographs, print and any other form of media now known or hereafter invented. I acknowledge that the Children’s Defense Fund shall own all right, title and interest in and to this media. I further agree that the Children’s Defense Fund may cause all of parts of this media to be used for any and all of its publications, exhibitions, public displays, editorials, advertising or for other purposes. I agree that I have not been paid, have not received other consideration and have no monetary rights to the audio recordings, films, videos or photographs and that such media belongs to the Children’s Defense Fund.

 

I waive any right of inspection or approval of the media or any advertising or publicity in which my name, voice, appearance, likeness, narrative or comments might appear. I expressly release, discharge and agree to hold harmless the Children’s Defense Fund and its agents, employees, licensees, affiliates and assigns from and against any and all claims including, but not limited to, invasion of privacy and misappropriation that I might have now or at any time in the future in any way relating to my interview of its use.

 

I understand this permission signifies that photographic, audio or video recordings of me may be electronically displayed via the Internet or in other public settings. There is no time limit on the validity of this release nor is there any geographic limitation on where the materials contemplated hereby may be distributed.

 

I acknowledge that I have completely read and fully understand the above release and agree to be bound hereby. This release shall be binding upon me and my heirs, legal representatives and assigns.

If you have questions, please email cwebb@childrensdefense.org.