Permission Form

This form grants Ecology permission to use images and other materials.

Permission to use a photo, audio, video or quote

In submitting this form, you agree to the following:

I authorize the Washington State Department of Ecology to use my quote(s), photo(s), audio, and/or video, identified below, for educational or promotional purposes in any media, including Ecology websites.

I understand that my name may be used on these materials unless I request otherwise.


Please describe the material you're allowing Ecology to use.
Please identify the Ecology project or person that requested this material.
For whom are you granting permission? *

Contact information

We will send a copy of this form to the email address you provide.
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To request this form in an alternate format, contact Ecology's ADA Coordinator by email at, or call 360-407-6831. People with impaired hearing may call Washington Relay Service at 711. People with speech disability may call TTY at 1-800-833-6384.