Skip to the content
Level 1:
Login
Level 1:
Get Help
Level 1:
Careers
Level 1:
ASL Videos
Level 1:
Site Map
Level 1:
Donate
Search for:
Search
Expand menu
ASL videos
Main navigation:
Facebook
Twitter
Instagram
YouTube
Level 1:
About Us
Level 2:
How We Began
Level 2:
Mission, Vision, and Values
Level 2:
Leadership
Level 2:
Funding
Level 2:
Newsletters
Level 1:
What We Do
Level 2:
Selecting Our Priorities
Level 2:
How We Help
Level 2:
Client Success Stories
Level 2:
Press Room
Level 2:
DRTx in the News
Level 2:
Staff Blog
Level 1:
Get Help
Level 2:
Self-Advocacy Resources
Level 2:
Intake Process
Level 2:
How We Decide What Cases We Take
Level 2:
How to Apply for Services
Level 2:
Appeals and Complaints Process
Level 2:
Other Sources for Help
Level 2:
Website Accessibility
Level 1:
Get Involved
Level 2:
Donate
Level 2:
Get Social/Subscribe
Level 2:
Volunteers
Level 2:
Events
Level 2:
Careers
Level 2:
Speaker & Exhibit Requests
Level 1:
Resources
Level 2:
Accessibility
Level 2:
Community Living
Level 2:
COVID-19
Level 2:
Disaster Preparedness and Recovery
Level 2:
Education
Level 2:
Employment and VR Services
Level 2:
Healthcare
Level 2:
Housing
Level 2:
Institutional Rights and Civil Liberties
Level 2:
Supported Decision-Making
Level 2:
Transportation
Level 2:
Voting
Level 1:
English
Facebook
Twitter
Instagram
YouTube
Subscribe
Get Help
Donate
Subscribe
Get Help
Donate
Client Publicity and Media Release Form
Authorizations to use photographs and information for publicity purposes
"
*
" indicates required fields
I am:
*
Required
the Client
Parent of minor child who is the client
Managing conservator of minor child who is the client
Guardian of the adult client
Name of Parent/Guardian/Managing Conservator
*
Required
First
Last
Name of Client
*
Required
First
Last
Name of attorney or advocate who worked on my case
Email
*
Required
Enter Email
Confirm Email
Phone (mobile number is preferred)
*
Required
I prefer to be contacted by:
*
Required
Email
Phone
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
I agree that for publicity purposes, DRTx may use (CHECK ALL THAT APPLY):
*
Required
Publicity purposes include but are not limited to publishing the material in/on annual reports, newsletters, websites, social media, press releases, donation campaign messaging, etc. in order to show the kind of work conducted by DRTx. DRTx will not sell or otherwise use the material for commercial purposes.
General information about how DRTx assisted client in the case
Photographs I have given DRTx
First name only of client
Full name of client
Photographs taken by DRTx
Photos available online
A video recording of an online or in-person legal clinic in which I was a participant
What languages do you have fluency in speaking?
English
Spanish
Vietnamese
Chinese
Other
Availability for News Interviews
*
Required
Please let us know days of week and times of day you are available for possible interviews with reporters. (If this does not apply to you, type N/A.)
Other Information
*
Required
Is there any other information you would like for us to know? If not, just type in "no"
Agreement
*
Required
Please click next to the agree button below to give permission to Disability Rights Texas to use all above that you have selected for publicity purposes as stated. After this you will also be asked to type out your first and last name and the date to confirm your agreement.
I agree.
In addition to clicking on "I agree" above, please also type your first and last name and today's date indicating your agreement.
*
Required
