Contact Information, Emergency Contact, and Release Forms

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Please complete the information on this form to ensure that the School of Divinity has your most recent contact information on file, as well as appropriate release preferences related to any photography or video footage that may be taken of you by the School of Divinity or any third party representers.

Your Information

Name(Required)

Preferred First Last

New Address(Required)

Street Address Address Line 2 City State ZIP Code

Do you live in an apartment complex? If so, which one?

WFU Email(Required)

When did you enter the MDiv program?(Required)

Cell Phone Number(Required)

Date of Birth(Required)

Religious Affiliation(Required)

School You Received Your Bachelors Degree From(Required)

Your Hometown (City, State)(Required)

Emergency Contact Information Person 1

Name(Required)

First Last

Relationship to Person 1(Required)

Preferred Phone(Required)

Email(Required)

Emergency Contact Information Person 2

Name(Required)

First Last

Relationship to Person 2(Required)

Preferred Phone(Required)

Email(Required)

Medical Information

Do you have any allergies, disabilities, or special health considerations?

Photo Directory Approval and Photo Release

Photo Directory The Wake Forest University School of Divinity maintains a photo directory that includes information on School of Divinity faculty, staff, and currently enrolled students.

The photo directory, called “Intranet,” is a secure online directory accessible only by School of Divinity faculty, staff and students. The directory is accessible only by entering an approved Wake Forest network username and password. Due to FERPA (Family Education Rights Protection Act) regulations, all students must indicate “yes” or “no” regarding their inclusion/exclusion in the School of Divinity Photo Directory. For the full FERPA policy related to directory information visit http://registrar.wfu.edu/services/privacy/ and http://registrar.wfu.edu/files/2012/06/ferpa.pdf.

The Photo Directory will include the following information that has been gathered from your admissions application and the Wake Forest campus database system.

• A headshot photo taken by the School of Divinity • Your first and last name • Your preferred first name (if you have previously indicated this on your admissions application) • Your Wake Forest email address • Your degree program • The year you will graduate • Your denomination • Your previous school attended • Your hometown

General Photography and Videography Release I hereby authorize Wake Forest University School of Divinity, hereafter referred to as “School,” to publish photographs and videos taken of me, and my name and likeness, for use in the School’s print, online and video-based marketing materials, as well as other School publications.     I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs or participation in company marketing materials or other School publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever.    I hereby release the School, its faculty and staff, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation.

Yes, I agree and understand the information as outlined above.

No, I do not agree and do not wish to have photos of me used in any capacity.

Phone

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Your Information

Emergency Contact Information Person 1

Emergency Contact Information Person 2

Medical Information

Photo Directory Approval and Photo Release

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