SUNY Oswego Summer Intensive English Program - Release Form

Name

First Name

Last Name

Email

PHOTOGRAPH RELEASE & CONSENT

I hereby irrevocably consent and authorize the State University of New York at Oswego to use and reproduce any photograph and any other like images of myself, for any purpose whatsoever, without any compensation to me. All such images shall solely constitute the property of the State University of New York at Oswego.*

Yes No

Signature For Photograph Release

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MEDICAL INSURANCE ACKNOWLEDGEMENT

ALL students in the Intensive English Program MUST have medical insurance. I understand that I am required to have medical insurance. The cost is $151.44 (3-week program), $302.88 (6-week program). This cost has been included in the overall program fee.

Signature

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Date/Time

ROOMMATE REQUEST

Rooms in the residence hall are corridor style, double occupancy. If you know someone you would prefer as a roommate, please write the name of your preferred roommate. The deadline to submit roommate request is May 01, 2020. We will NOT be able to accept the requests received after the deadline

DIETARY RESTRICTIONS

Do You Have Any Health Related Dietary Restrictions? (Food Allergy etc.)*

Yes No

Please list your health related dietary restrictions or allergies.

SUNY Oswego Summer Intensive English Program (SIEP) Release Form