Student Portfolio Permission Form

By signing below, I give my instructor, ____________________________, and the Writing Program at University of South Florida St. Petersburg permission to photocopy or save electronically the full or partial contents of my final portfolio, to keep those copies on file, and to quote from those copies for research purposes (professional presentations, articles, or textbooks).

If portions of my written work are used, my instructor agrees to change my name and to protect my identity if I check that option below (first names only). I also understand that if I check the second box below, my writing may be edited in accordance with publishers’ wishes.

I understand that the goal of this research is instructional and educational—and that my writing will be treated or presented respectfully. My instructor has assured me that signing or not signing this permission form will not affect my course grade in any way.

Optional:

___ I request that my first name be changed.

___ I give permission for my writing to be edited.

___ I can be reached at the following permanent address if questions arise about my portfolio:

               ___________________________________________________

               ___________________________________________________

               ___________________________________________________

Signature: ________________________________________________

Printed Name: _____________________________________________

Date: ____________________________________________________

I, _________________________, have read, understand, and will abide by the course requirements and policies laid out in this English 1102 syllabus and explained on the first day of class.

                                                                                    Signed: _____________________________

                                                                                    Date:      ______________________________

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