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Student Permission to Use Information Outside the Online Course

Student’s Name _______________________     Course __________________

Instructor’s Name _____________________  Semester/Year ______________

I grant the Instructor identified above unlimited permission to make public or reference those items checked in the list below. This permission applies to work I have completed in the course indicated.

  • My comments in chats
  • My comments in electronic forums
  • My comments in e-mail
  • Examples of my written work
  • My name as part of a directory listing of students in the class
  • My photograph
  • My biography
  • My anonymous course data as part of aggregated data with other course members
  • Other:

I understand that when my work is used, if possible, an acknowledgement identifying the work as mine will be included.

q       I accept.                                             

q       I do not accept.

Adapted from Waterhouse, S. & Rogers, R., The importance of policies in e-learning instruction, Educause Quarterly, #3, 2004.

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