Success Story and Photo Consent Form
Oklahoma ABLE Tech Success Story and photo consent form. Please complete the online questions, then print in order to obtain the signature, then click submit. Please fax, scan and email, or mail the signature page to ABLE Tech. fax number is 405-744-2487. Address 1514 W. Hall of Fame Stillwater, OK 74078. email: firstname.lastname@example.org
* Indicates Required Field
Please answer the following success story questions about an individual with a disability, family, or a service provider served through the loan or demonstration program. Please make these entries as specific as possible including examples that are understandable to an uninformed audience. Please submit to ABLE Tech along with a digital picture of the individual preferably using the assistive technology device. The individual or a guardian must sign the consent form. This form can be filled out, then printed to obtain the signature, then click submit. In ABLE Tech articles, we typically include the individual's county, age, and disability. We appreciate hearing about all of your successes - big or small!
By signing this form, you allow us to use your success story and/or your picture. We may use the information in the Oklahoma ABLE Tech newsletter, annual report, a local newspaper story, or brochures that publicize the services through Oklahoma ABLE Tech, the assistive technology program of Oklahoma. I give my permission for Oklahoma State University, through Oklahoma ABLE Tech employees and participants of ABLE Tech programs, to photograph me and my property and in turn give the photograph and related assistive technology information to Oklahoma ABLE Tech of Oklahoma State University. I understand the information/photograph may be copyrighted, published and/or reproduced thereof, in color or otherwise, made through any media at Oklahoma State University studios or elsewhere. I agree that all rights to the picture belong to ABLE Tech and waive the right to inspect and/or approve the finished product that may be used in connection therewith, or the use to which it may be applied.