SOP_NUMBER: 102.01-att-1
TITLE: Interview Request Form (Attachment 1)
REFERENCE_CODE: IJ01-0001
DIVISION: Executive
TOPIC_AREA: 102 Policy-Office of Communications
EFFECTIVE_DATE: 2022-07-14
WORD_COUNT: 229
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105666
URL: https://gps.press/sop-data/102.01-att-1/

SUMMARY:
This form is used to document an offender's or employee's consent to be interviewed by media representatives and to authorize the Georgia Department of Corrections and news agencies to use their name, image, voice, and recordings for publication and institutional purposes. The form includes a liability release and notifies offenders to consult with their attorneys if involved in pending legal proceedings. It also provides an option for individuals to decline media interviews.

KEY_TOPICS: media interview, consent form, offender interview, news media, release form, public affairs, media request, liability release, voice recording, videotape, still pictures

ATTACHMENTS:
  1. Interview Request Form (Attachment 1)
     URL: https://gps.press/sop-data/102.01-att-1/
  2. Pool Participant Agreement
     URL: https://gps.press/sop-data/102.01-att-2/
  3. Interview Conditions & Agreement Form
     URL: https://gps.press/sop-data/102.01-att-3/

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FULL TEXT:
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SOP 102.01
Attachment 1

7/14/22


_GEORGIA DEPARTMENT OF CORRECTIONS_
# **INTERVIEW REQUEST FORM**

I, ___________________________________ / ________________________________, herby grant permission
**(Offender Name/GDC Number)** **(Employee Name/Number)**

to the Georgia Department of Corrections and _____________________________________________ to make use of
**(Publication, Station, News Agency)**
my name, comments, still or motion pictures, voice recordings or videotape of me for any legitimate purposes including
publication in news media and for professional and institutional purposes.

I hereby release and hold harmless the GDC, its agents and servants from any and all claims for damage for libel,
slander, invasion of the right of privacy or any other claim based on the use of said material.

The above consent is given by me freely and voluntarily without any promises, threats, or duress.

(Staff Signature/Number) (Date)

(Offender Signature/ GDC Number) (Date)

(Witness Signature) (Print Name, Title)

**Notice:** **Offenders who are a party to any pending or anticipated legal proceeding are advised to notify their**
**attorneys prior to conducting a media interview.**

**DENIAL OF INTERVIEW REQUEST**

I decline to be interviewed by the media representative from _________________________________ on this date.

(Offender Signature/GDC Number) (Date)


Retention Schedule: Upon completion of request by offender, the form is to be retained in the offender’s institutional
file and held according to the retention schedule for offender’s institutional file.

Upon completion by an employee, the form will be retained in the Public Affairs Office for three (3) years.