I understand that my contact information may be shared for other purposes related to the MO-SECA program, including publicly listing my organization as a participant.

I understand that by agreeing to participate in this program, I agree to be contacted by and coordinate with representatives with partner organizations affiliated with the program, which may include UMKC Institute for Human Development, UMKC Midwest Center for Nonprofit Development, UMSL Community Innovation and Action Center, University of Missouri – Extension, Missouri Small Business Development Centers, and Child Care Aware of Missouri.

I hereby authorize and permit the UMKC Institute for Human Development (UMKC IHD) to
create, use, publish, and disseminate photographs, video, or audio of my participation in its
programs. I understand these may be used for the promotion and benefit of UMKC IHD and
the University of Missouri System, and that I will not receive compensation for their usage. I
also agree that no inducements or promises have been made to me to secure my consent to this authorization.

By participating in this program, I understand that regular attendance and participation in the trainings and program modules is required in order to complete the program and receive the participation stipend.

Thanks for your interest in MO-SECA!