Broward College
Academy for Excellence (BCAE)
Student Application / For office use only
Residency completed? ___
Admissions holds removed? ____
Registered for BCAE orientation? ____
Registered in BCAE classes? ___
Completed 2015-2016 FAFSA? ___
Completed 2016-2017 FAFSA? ___
Completed Release Form? ___
Name
Address
Phone Number______Date of Birth (MM/DD/YYYY) ______
E-mail address ______
High School ______
Broward College Student ID #______High School Student ID#______
Print Name
Student Signature ______Date: ______
Central Campus / North Campus / South Campus
Joevania Alexandre / Alicia Smith Wroble / Alina Tulloch
/ /
954-201-6358 / 954-201-2310 / 954-201-8259
Put a check mark next to your preferred campus.
Email your completed application and Release Form to the contact person at the campus you selected.
PHOTOGRAPHIC CONSENT AND RELEASE FORM
I hereby authorize BROWARD COLLEGE (“BC”) and those acting pursuant to its authority to:
(a) Record my likeness and voice on a video, audio, photographic, digital, electronic or any other device or medium;
(b) Use my name in connection with these recordings; and
(c) Use, reproduce, exhibit or distribute in any medium (including but not limited to, print publications, video tapes, CD-ROM, Internet, social media, or any other medium) these recordings for any purpose that BC, and those acting pursuant to its authority, deem appropriate, including promotional or advertising efforts.
I release BC and those acting pursuant to its authority from liability for any violation of any personal or proprietary right I may have in connection with such use. I understand that all such recordings, in whatever medium, shall remain the property of BC, and that I will not receive any compensation for the use of such recordings. I have read and fully understand the terms of this release.
Name:
Address:
City:_
State: Zip:
Email:
Phone:
Signature: Date:
Parent/Guardian Signature (if under 18):
Date:
Photo consent form
9/2014