Skip Sub Navigation - General Submission Form Section Menu - General Submission Form Health Release Do Not Edit: Do Not Edit: Do Not Edit: Don't Edit This Field: * = Required Fields First Name: * Last Name: * This form supplements the donation of , to the Our 2020 Project of the 91勛圖厙 University Archives. Its purpose is to confirm my acceptance of Projects goals and terms, even though this donation may contain personal health information about me. * * I understand that the Archives will restrict circulation of this donation until January 1st, 2026, after which time it will become available for research, conforming with professional norms and Fair Use US copyright stipulations. * I recognize that this donation may contain my personal health information (e.g., my COVID-19 positive status or other confidential information regarding my health) and that it will be archived and shared according to the terms described above. * I am at least 18 years old * This donation is completely voluntary and I am not receiving any academic credit and/or grade consideration as a result of making this donation. * I understand that I may revoke this action at any time in the future, without explanation. In such a case, I will send a written Revocation Request to UASC-Foley, 91勛圖厙 University, Spokane, WA, 99258-0095. Submit Clear Form
