Nicholas Green
Distinguished Student Award
Release Form

 Awards Page     Nicholas Green Award Application

I hereby give the National Association for Gifted Children (NAGC) and the Massachusetts Association for Gifted Education (MAGE) permission to use my son / daughter's photo and composition, submitted in connection with the NAGC - Nicholas Green Distinguished Student Award, in any publicity or announcements NAGC or MAGE may make about the Award or the Award winners, should my son or daughter be selected for the Award. I further grant permission to NAGC and MAGE to use my son / daughter's name, school name, and city and state in any publicity or announcement that uses his / her photo or composition, and to make edits to the length of the composition as may be necessary. I understand that neither I nor my son / daughter will receive any remuneration in connection with this permission and understand that the photo and composition will not be returned to me.

Signature________________________________________________________
Name (please print)______________________________________________
Address__________________________________________________________
City/State/Zip___________________________________________________
Phone(day)________________________ email_________________________
Relationship to Student Award Nominee____________________________
Name of Student Nominee__________________________________________
Student's Social Security Number(necessary to purchase Bond)     
_________________________________________________________________
State__________________________ Date_____________________________

   Awards Page     Nicholas Green Award Application