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                                     SIUE School of Business International Program
                                     Annual Photo Award
                                     Entrance Form                       7/7/2010



                                                         Entries are due by 4:30 pm,
                                                         on Friday, Oct. 15, 2010.
Name: ___________________________________
SIUE ID: 800 -_______________ E-mail: ____________________________________
Primary phone: (_____)______________ Alternate phone: (_____)________________


Current Address:__________________________________________________________
City: ______________________________ State: _______ Zip: _____________________


Permanent Address (if other than above): ____________________________________
City: _______________________________ State: _______ Zip: ____________________


SIUE Enrollment Classification (circle one):         Undergraduate             Graduate
Year (if undergraduate):     Freshman    Sophomore       Junior    Senior
Degree Program: ___________________________
Major: ____________________________ Minor: ____________________________


Travel Study or Study Abroad participated in: _______________________________
Date of Participation: _____________________________________________________


Photos submitted can be submitted under the category of a single photo, or a themed
series. (A theme series consists of 3 to 5 photos working in tandem which relates your
experience abroad).


First Entry:
Title of photo/series:
__________________________________________________________
Location of photo/series:
______________________________________________________
Date(s) taken: ______________________
Media:
   □   Digital (Please send files in the manner indicated on the International Photo Award
                                                                                            2
       Information for Participants – at
       http://www.siue.edu/business/international/PhotoAward.shtml- to
       ldierke@siue.edu)
   □   Hardcopy (Please attach a label to the reverse of the photo, with information
       indicated on the International Photo Award Information for Participants. Photo is
       securely attached to this application and delivered to Lauren Dierkes, FH 3301.)

Please identify SIUE students pictured in the photo, as well as others pictured, if
possible:

   □   Please check this box to confirm that all SIUE students who appear in this picture
       have given you permission to use it in this award.


Second Entry:
Title of photo/series:
__________________________________________________________
Location of photo/series:
______________________________________________________
Date(s) taken: ______________________
Media:
   □   Digital (Please send files in the manner indicated on the International Photo Award
       Information for Participants – at
       http://www.siue.edu/business/international/PhotoAward.shtml- to
       ldierke@siue.edu)
   □   Hardcopy (Please attach a label to the reverse of the photo, with information
       indicated on the International Photo Award Information for Participants. Photo is
       securely attached to this application and delivered to Lauren Dierkes, FH 3301.)

Please identify SIUE students pictured in the photo, as well as others pictured, if
possible:

   □   Please check this box to confirm that all SIUE students who appear in this picture
       have given you permission to use it in this award.


Please submit the following with your application:
   □   A signed Consent and Release (form is below).
   □   The photograph(s) you are submitting, either digitally or in hard-copy.

Awards:

       Five prizes will be awarded for selected work, as follows:
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           o   Grand Prize: One award of $200
           o   First Prize: One award of $100
           o   Second Prize: One award of $50
           o   Honorable Mention: Two awards of $25 each

       Winners will be announced near the end of fall semester 2010 and honored during
       the Scholarships and Awards Ceremony in April 2011.

                School of Business International Program
                  Photo Award - Consent and Release
I have read, understand, and accept the rules of the School of Business International
Program Photo Award, as stated at
http://www.siue.edu/business/international/PhotoAward.shtml.

I grant the School of Business International Program and others at SIUE permission to
duplicate, distribute, and/or publish any of the photos I have submitted for the purposes of
display, marketing, promotion, and/or education. I also grant permission to SIUE to edit,
crop, retouch, or otherwise alter the photos. I waive any privilege to inspect such images
prior to publication, and I authorize the use of these images indefinitely without
compensation to me. I understand that materials submitted will not be returned to me. All
photographs and images submitted will become property of SIUE.

I confirm that the photo(s) submitted are my work and that the photo(s) were taken while I
was abroad participating in a School of Business International Program between the dates
of Sept. 1, 2009, and August 31, 2010.

I also agree that the information submitted here is complete and accurate to the best of my
knowledge.


Signature: ________________________________                  Date: __________


 Please return completed application by Friday, Oct. 15, 2010, at 4:30 pm:
               Lauren Dierkes
               SIUE School of Business International Program
               Mail Code 1051, Office: FH 3301
               Edwardsville, IL 62026-1051
               Email: ldierke@siue.edu
               Office phone: 650-2922
               Fax: 650-3979

				
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