you are not ugly foundation LAUNCH PROJECT

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Full Name *

Instagram handle *

Can we tag your Instagram handle in our social media post? *

Yes

What is one negative label that you have overcome or are trying to overcome? *

What is a piece of advice that you would tell your younger self/others to help overcome society's labels? *

Please submit a headshot/photo of yourself that you feel comfortable having posted on the @youarenotuglyfoundation Instagram page. You can submit this photo by dm’ing it to the @youarenotuglyfoundation IG page or to @saniyakaushal. You can also email your photo to inquiries@saniyakaushal.com. After completing this step, please indicate how you have submitted your photo. Please note that participants who do not complete this step of the form will be ineligible to receive a free self-care package. *

Instagram DM’d to @youarenotuglyfoundation

Instagram DM’d to @saniyakaushal

emailed to inquiries@saniyakaushal.com

Authorization, Release, and Consent *

I authorize and grant ‘you are not ugly foundation’ to use my submitted photo and responses on their Instagram and other social media platforms.

I allow ‘you are not ugly foundation’ to edit, alter, copy, or distribute my submitted photo and responses for social media advertising and marketing *edits will not be made in a matter that misrepresents the participant (they might include grammatical adjustments, picture + text layover, black and whiting etc.)

I understand that I will not receive any monetary compensation for my participation

TakingITGlobal may collect, use, produce, reproduce, publish and communicate my personal information contained in the capture of interviews, images, likeness or voice via photograph, audio/video recordings or written account captured, for the purpose of promoting TakingITGlobal’s #RisingYouth program internally or externally, in any format or medium, including the Internet and/or social media (eg, Twitter, Facebook, YouTube and LinkedIn).This information may be shared with third parties for the purpose of promoting #RisingYouth and TakingITGlobal’s programs and services.

I am 19 years old or older. If I am younger than 19 years old, my parents/legal guardians authorize my participation in this initiative and agree to the above terms

Required

Please provide a virtual signature below by writing your full name and the date to represent your agreement with the terms listed above. *

If under 19 years old, please provide virtual signatures below by writing your full name and having your parent/legal guardian provide their full name and date to represent yours and their agreement with the terms listed above. If not applicable, please write N/A *

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