2021 Homecoming Media Request Form

I am requesting the following media credentials (please select all that apply):
Please indicate "other":
Please select all the mediums that apply:
Please indicate "other":
Name of Organization/Affiliate:
Working Title:
Phone Number:
Email Address:
Web Address:
Social Media Handles:
Approved photographer or videographer credentials will need to provide flash drive, cloud drive or website access of all photos and videos to North Carolina Central University. I hereby grant NCCU to use my photographs or videos in any and all publications, including website, promotional material, and etc., without payment or any other consideration of perpetuity. I hereby authorize NCCU to edit, alter, copy, exhibit, publish or distribute these photos or videos. 
Please select AGREE or DISAGREE:
Date Submitted:
Thank you for your interest. This form does not guarantee media approval. Please ensure this form is filled out completely. Indicate "N/A" where necessary. You will only receive a confirmation email if your media request is approved.

Thank you,

Ariel V. Germain
(919) 530-7474