Case Study Release Form

Case Study Release Form

Please complete this form to obtain consent for using an individual’s information, feedback, or experience in a case study.

Participant Information

Name

    Email

      Phone number

        Project/Case Study Details

        Case Study Title

        Organization Conducting Study

          Project Description

          Consent Authorization

          I give permission to [Organization's Name]to use my information, feedback, and/or experience for the purposes of this case study. I understand that this may include, but is not limited to, publication in reports, articles, and other materials.

          Participant Signature

          Name:

          Date:

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