Emory Cares: Project Submission Form

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Project Lead Contact Information

First Name

Last Name

Email

Emory Affiliation

Class Year

Please expect an Emory Cares event package shipped 1-2 days prior to your project.

Recipient Name

Shipping Street Address 1:

Shipping Street Address 2:

Shipping City:

Shipping State

Shipping Zip/Postal:

Shipping Country

Shipping Phone Number

Shipping Home or Business

I have Co-Leads on this project

By submitting this form, I give Emory University the right to photograph, videotape or otherwise record or collect my name, likeness, voice and sounds ("Works") during my attendance at the event. I irrevocably assign and grant to Emory all rights in these Works and the right to use or sublicense these Works and my name, likeness and biography, in Emory’s discretion, in all media and for any purpose, including without limitation, advertising and other promotions for Emory, without any further consideration to myself or my heirs, assigns, or legal representatives, and without any right to review any such use beforehand.

Additional Project Leads

Project Co-Lead First Name

Project Co-Lead Last Name

Project Co-Lead Email Address

Project Co-Lead Emory Affiliation

Project Co-Lead Class Year(s)

Project Co-Lead 2 First Name

Project Co-Lead 2 Last Name

Project Co-Lead 2 Email Address

Project Co-Lead 2 Emory Affiliation

Project Co-Lead 2 Class Year(s)

Project Information

Project Title

Alumni Network Affiliation (if applicable)

Project Date

Start Time

End Time

Detailed Project Description (to be utilized for marketing purposes)

Organization Name

Organization Website

Physical Address of Volunteer Site

Directions

Parking Information

Will guests need to register using an external link (i.e., the volunteer organization's registration system)?

If yes, please provide external registration link

Suggested Attire

Maximum number of volunteers

Minimum age for participants

Final head count date

Walk-ins allowed?

Additional Info?

Any additional information

Project Impact or Goal

Confidentiality Agreement

Please read the following carefully before indicating your agreement:

Thank you for your willingness to assist with Emory's alumni outreach efforts.

As an alumni volunteer, you will be granted access to information that may include alumni names, mailing addresses, phone numbers, email addresses and other identifying or background information. For convenience, we will refer to all such information as “Alumni and Friend Information.”

The purpose of this form is to confirm that all such information is confidential and to ask for your commitment to treat Alumni and Friend Information as confidential. Specifically, by receiving Alumni and Friend Information from Emory, we request the following:

That you treat all Alumni and Friend Information as confidential, and that you refrain from disclosing it to any third party and from using it in any way, except for the purpose for which the information was provided, namely, to enable you to make contact with prospective donors or volunteers.
That you maintain the security of any Alumni and Friend Information that is provided to you, including any Alumni and Friend Information provided in an electronic format.
That you destroy or return to Emory all copies of Alumni and Friend Information that you receive from Emory after you have completed your efforts to reach out to any prospective donors or volunteers identified to you.

As you would expect, these obligations will apply during and after your participation in Emory’s alumni outreach efforts, and they will continue to apply for as long as the information in question remains confidential.

To confirm your commitment to these obligations, please enter your name, today's date, and include your initials below "Agreed and Accepted" in the space indicated below.

For legal purposes, we are required to note that your counter-signature of this letter is a term and condition of Emory’s willingness to provide you with Alumni and Friend Information and to work with you in connection with our alumni outreach efforts.

First Name

Last Name

Class Year

Email

Today's Date

Agreed and Accepted (please check)

Agreed and Accepted (please initial)