English as a Second Language Intake Form

Please provide your legal sex as denoted on your birth certificate or driver’s license per WAC 246-490-075 or WAC 308-104-0150. Gender Identity is collected after admission to the college and in student self-service.

I, the undersigned, consent to each and every use by Bellevue College, and all of its officers, employees, and agents of 1) each photograph, videotape or other likeness of me taken/recorded on (date) and/or 2) comments provided in interviews on (date) and/or in writing. Such uses may include, but are not limited to, every use in a publication, newspaper, advertisement, web site, videotape presentation, television show or other publication or recording. I also waive any right to compensation for such uses, or to inspect or approve the uses beforehand. I release Bellevue College, its legal representatives and all persons acting under its permission or authority, from any liability for any blurring, distortion, alteration or optical illusion that may occur with these pictures. I, the undersigned, consent to each and every use by Bellevue College, and all of its officers, employees, and agents of 1) each photograph, videotape or other likeness of me taken/recorded on (date) and/or 2) comments provided in interviews on (date) and/or in writing. Such uses may include, but are not limited to, every use in a publication, newspaper, advertisement, web site, videotape presentation, television show or other publication or recording. I also waive any right to compensation for such uses, or to inspect or approve the uses beforehand. I release Bellevue College, its legal representatives and all persons acting under its permission or authority, from any liability for any blurring, distortion, alteration or optical illusion that may occur with these pictures.