e2 Fellowship Application

September 29 | November 17 | January 26 | March 16 (tentative)

I understand that the photographic image(s), video(s), and/or audio recording(s), in which I am a participant/subject, is(are) being produced and owned by Mosaic Life Care Foundation. I hereby acknowledge that my participation may be edited and used in whole or in part as desired in any way by the Foundation including, but not limited to, being reproduced, duplicated, and used for non-theatrical audiovisual informational, public relations, fund development, and general education purposes. I also consent to the use of my likeness and voice for all purposes listed above in connection with the images and audiovisuals through traditional print, radio, television and/or online media platforms for an indefinite period of time. I understand that my signature indicates that I have read, understand and approve of this photo release agreement.

e2 Fellowship will be offered free of charge for school districts in the Foundation's 31 county service region in northwest Missouri and adjacent counties in Kansas, Nebraska and Iowa. The 4 days of program facilitation, all materials, and lunches are provided. Transportation or lodging costs are not included. Applicants are accepted on a first-come, first-served basis for up to 20 teams.