Volunteer Information

• First name
• Last name
• Phone number
  ext.
• Email address (i.e. name@isp.com)
• Description

  (Please provide as much identifiable information about the RPCV as possible: assignment, host country, years of service, gender, home state, and age during service. This information is invaluable in helping us review and select stories.)

Returned Volunteer Information

If Author and RPCV are not the same, please fill out the following:

• First name
• Last name
• Phone number
  ext.
• Email address (i.e. name@isp.com)

Story Information

• Title
• Text
• Disclaimer: Personal information is for fact-checking and copyright issues, only. We may contact you to confirm some Volunteer information.

Authorization to Use Personal Material

• By clicking "Submit Story" I hereby grant to the Peace Corps a perpetual, worldwide, royalty-free, non-exclusive license to use, reproduce, or publish, for purposes authorized by the Peace Corps Act: my name; my articles and stories; and any other documents, writings, statements, recordings, representations, or information I may provide pursuant to and in accordance with the terms of this Authorization.

  In particular, I hereby authorize the Peace Corps to use, reproduce, or publish any or all of the above-listed items and to make reference to me in connection with these items to promote the Peace Corps using various media and publicity means, including, but not limited to: websites; books; public service advertising on television and radio stations; television and radio broadcasts; direct mail pieces; print advertisements; brochures; flyers; posters; articles; editorials; speeches; roundtable discussions; radio interviews; and television programs.

  I acknowledge that I will receive no compensation from the Peace Corps in consideration of this Authorization or the use of the above-listed items pursuant to this Authorization.

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