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Teacher/Book of the Month Shoutout a Star Form
Teacher/Book of the Month Shoutout a Star Form
Section 1: Nominator Information
Full Name
(Required)
Email Address
(Required)
Phone Number
Your Role
(Required)
Parent/Guardian
Teacher
Director
Community Member
Student
Other - specify if Other selected)
Specify if Other selected)
Section 2: Category of Nomination
What are you nominating?
(Required)
Teacher of the Month
Book of the Month
Section 3: Teacher Nomination
Teacher's Full Name
(Required)
Center/School Name
Age Group the Teacher Works With
Infant
Toddler
Preschool
PreK
Mixed-Age
School- Age
Why are you nominating this teacher?
(Required)
Tell us about their impact, kindness, creativity, and/or how they inspire children and families.
Would you like to upload a photo or evidence of excellence?
(Required)
Yes
No
Upload a photo or evidence of excellence (File Upload)
(Required)
Drop files here or
Select files
Max. file size: 128 MB.
CAPTCHA
UNIVERSITY OF NEW MEXICO PHOTO, VIDEO and SOUND RECORDING RELEASE and CONSENT FORM
(Required)
Electronic Signature of Participant: By checking this box, I am applying my electronic signature to the below form. I agree to the UNIVERSITY OF NEW MEXICO PHOTO, VIDEO and SOUND RECORDING RELEASE and CONSENT FORM.
By signing this Photo, Video and Sound Recording Release and Consent Form, you are irrevocably giving permission to the Regents of the University of New Mexico and the University’s officers, agents, employees, successors, licensees, and assigns to take and use photographs, video or sound recordings of you for the following project___________________________. This is completely voluntary and up to you.
Your consent to the use of the photographs, video and sound recordings and your image, likeness, appearance, and voice is for forever. You will not receive compensation for the use of your image, likeness, appearance, and voice now or in the future. The University may use the photographs, video and sound recordings containing your image, likeness, appearance and voice in any manner or media, including use on web pages. The photographs, video and sound recordings may be used in whole or in part, alone or with other recordings. The photographs, video and sound recordings may be used for any educational, institutional, scientific or informational purposes whatsoever, but not for any commercial uses. The University has the right and may allow others outside the University to copy, edit, alter, retouch, revise and otherwise change the photographs, video and sound recordings at the University’s discretion. All right, title, and interest in the photographs, video and sound recordings belong solely to the Regents of the University of New Mexico.
You further give permission to the University to use your name, biography, and any other personal data, events, or other material in or in connection with any such uses of the photographs, video and sound recordings.
I understand and agree to the conditions outlined in this photograph, video and sound recording release and consent form. I irrevocably give consent to the Regents of the University of New Mexico and the University’s officers, agents, employees, successors, licensees, and assigns forever to make use of my image, likeness, appearance, and voice in photographs, video and sound recordings as described above. I acknowledge that I am fully aware of the contents of this release and am under no disability, duress, or undue influence at the time of my signing of this instrument.
Printed Name of Participant:
Signature of Participant:
Date:
Name
(Required)
First
Last
Date
(Required)
MM slash DD slash YYYY
Section 4: Book Nomination
Title of the Book
(Required)
Author
Age Range for the Book
Infant
Toddler
Preschool
Early Elementary
• Why are you nominating this book?
(Required)
Share why it’s powerful, relevant, inclusive, or promotes learning and joy.
Would you like to upload a photo of the book or activity using it?
(Required)
Yes
No
Upload a photo the book or activity using it (File Upload)
(Required)
Drop files here or
Select files
Max. file size: 128 MB.
UNIVERSITY OF NEW MEXICO PHOTO, VIDEO and SOUND RECORDING RELEASE and CONSENT FORM
(Required)
Electronic Signature of Participant: By checking this box, I am applying my electronic signature to the below form. I agree to the UNIVERSITY OF NEW MEXICO PHOTO, VIDEO and SOUND RECORDING RELEASE and CONSENT FORM.
By signing this Photo, Video and Sound Recording Release and Consent Form, you are irrevocably giving permission to the Regents of the University of New Mexico and the University’s officers, agents, employees, successors, licensees, and assigns to take and use photographs, video or sound recordings of you for the following project___________________________. This is completely voluntary and up to you.
Your consent to the use of the photographs, video and sound recordings and your image, likeness, appearance, and voice is for forever. You will not receive compensation for the use of your image, likeness, appearance, and voice now or in the future. The University may use the photographs, video and sound recordings containing your image, likeness, appearance and voice in any manner or media, including use on web pages. The photographs, video and sound recordings may be used in whole or in part, alone or with other recordings. The photographs, video and sound recordings may be used for any educational, institutional, scientific or informational purposes whatsoever, but not for any commercial uses. The University has the right and may allow others outside the University to copy, edit, alter, retouch, revise and otherwise change the photographs, video and sound recordings at the University’s discretion. All right, title, and interest in the photographs, video and sound recordings belong solely to the Regents of the University of New Mexico.
You further give permission to the University to use your name, biography, and any other personal data, events, or other material in or in connection with any such uses of the photographs, video and sound recordings.
I understand and agree to the conditions outlined in this photograph, video and sound recording release and consent form. I irrevocably give consent to the Regents of the University of New Mexico and the University’s officers, agents, employees, successors, licensees, and assigns forever to make use of my image, likeness, appearance, and voice in photographs, video and sound recordings as described above. I acknowledge that I am fully aware of the contents of this release and am under no disability, duress, or undue influence at the time of my signing of this instrument.
Printed Name of Participant:
Signature of Participant:
Date:
Name
(Required)
First
Last
Date
(Required)
MM slash DD slash YYYY
Section 5: Final Notes
• Would you like your nomination to be public or anonymous?
Public
Anonymous
Any additional comments or notes?
Information
Quick Links and Useful Information
NM ECECD
nmececd.or
g
Early Childhood Education and Family Services Portal
search.newmexicokids.org
Moments Together NM
momentsnm.org
Am I Eligible Application for Child Care Assistance
eligibility.ececd.nm.gov
YES NM Portal Application for Services
yes.state.nm.us