Summer Artist / Educator Residency (SAER) Student Information & Permissions Form

Welcome Summer Artist / Educator Residency (SAER) participants! If you have completed your tuition payment, please submit the required form below to confirm your contact information and permissions.

** BEFORE COMPLETING THIS FORM, COMPLETE YOUR TUITION PAYMENT.

Questions? Please email our team at ce@moore.edu.

Student Information

First Name *

Preferred Name
**Please note that if provided, this will become the primary name used in future communications you will receive from the college. Otherwise, Legal First Name will be utilized.

Last Name *

Date of Birth *

Social Security Number *
(without dashes)

*** This information is required as a unique identifier for all enrolled students at Moore College of Art & Design.
Moore is required to file a Form 1098-T for each student we enroll and for whom a reportable transaction is made. Please note this platform is secure. For individuals who do not possess a Social Security Number, please contact our office directly for further assistance.

Race/Ethnicity

Are you Hispanic/Latinx?

Gender Identity *

Contact Information

Mailing Address *

Country

Street

City

Region

Postal Code

Email Address *

Phone *

I would like to receive text message updates from Moore College of Art & Design!

Dietary Needs

Do you have any special dietary needs or requests? *

Yes

If yes, please specify:

Emergency Contact Information

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Relationship *

Emergency Contact Phone Number *

Emergency Contact Email *

Academic Information

High School Name *

Other disciplines of interest:

Permissions

Photo Release

I hereby grant permission to Moore College of Art & Design, the rights of my image, in video or still, and of the likeness and sound of my voice, as recorded on audio or videotape. I understand that my image may be edited, copied, exhibited, published or distributed, and waive the right to inspect or approve the finished product, wherein my likeness appears.

Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

Photographic, audio or video recordings may be used for ANY USE which may include, but is not limited to:

Presentations
Courses
Online/Internet Videos
Media
News (Press)

By submitting this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet, or in the public educational setting. There is no time limit on the validity of this release, nor is there any geographic limitation on where these materials may be distributed.

By submitting this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.

I grant permission to the Moore College of Art & Design

I do not grant permission to the Moore College of Art & Design

Moore Student Photo ID

A headshot is needed for the purposes of creating your Moore Student ID. The ID will facilitate access in and around the building as well as serve as identification for security purposes during your time at Moore.

Make sure to upload a clear photo of your upper body and face!
How to Take a Proper Headshot

Preferred First Name to Appear on ID Card
**Please note if provided, this will become the primary name used in future communications from the college.

ID Photo

Please upload a front-facing headshot for your student ID.

Have you completed your SAER Tuition payment?

Yes

Is your employer funding your experience at SAER?

Yes, all of the cost

Yes, part of the cost