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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