MEDIA AUTHORIZATION FORM INSTRUCTIONS - webmedia unmc 2026

1. Begin by clicking ‘Get Form’ to open the Media Authorization Form in our editor.
2. Fill in your name, address, city, state, and zip code in the designated fields at the top of the form.
3. Provide a description of the information you are authorizing to be released and indicate any possible air/publication date.
4. Select your reporter/affiliation and check all applicable consent options: interview, photography, videotape, or other.
5. Read through the authorization statement carefully. If you agree, sign where indicated as either the individual or as a parent/guardian if applicable.
6. In the section regarding withdrawal of authorization, ensure that an employee's name and phone number are filled in.
7. The employee should sign as a witness and date the form before providing a copy to you.
8. Finally, ensure that the original form is retained and filed by the employee for record-keeping.

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