Consent Form|Saint Therese

Saint Therese Youth Volunteer Scholarship Consent Form

Consent Details
Applicant Name*
First Last
St. Therese Foundation, Inc. (Saint Therese) may use applicant name, age, essay submission, photographs, slides, videos or illustrations in newsletters or other communication produced by Saint Therese and subsidiaries as well as in slide presentations, videos, social media, print and electronic communications and websites about the scholarships by media in Saint Therese news coverage, in videos produced by Saint Therese and in other similar forms of communication.

Local media (TV, newspaper, radio stations) may interview applicants and recipients for stories. Applicant comments may be used in newspapers or broadcast on radio or TV.
Consent
I give permission to Saint Therese and news media to use applicant name, age, essay submission, photographs, slides, videos, illustrations or interviews. Further, I authorize use without inspecting or approving the finished product or its specific use.
Consent
I acknowledge the Youth Volunteer Scholarship is not transferable.
Consent
I have received and/or reviewed the Eligibility Criteria and confirm eligibility.
If applicant is 18 or over: Name of applicant
First Last
Consent
Signature of applicant: By checking this box, I agree I am signing this form electronically.
If applicant is under the age of 18: Name of consenting parent/guardian
First Last
Consent
Signature of consenting parent/guardian: By checking this box, I agree I am signing this form electronically.
Email*
Phone
hCaptcha*

1660 South Highway 100, Suite 103
Saint Louis Park, Minnesota 55416

New Hope 763.531.5000
Woodbury 651.209.9100
Brooklyn Park 763.493.7000
Shoreview 651.842.6781
Robbinsdale 763.581.8469

Nondiscrimination Policy and Language Assistance

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