Louisiana Lagniappe PTSA Reflections Student Entry Form

Louisiana Lagniappe PTSA Student Entry Form

Student Name*

Name of school student attends*

School's Address

Grade*

Age*

Parent/Guardian Name*

Parent/Guardian Email*

example@example.com

Parent/Guardian Phone*

Student's Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Consent

1) Ownership in any submission shall remain the property of the entrant, but entry into this program constitutes entrant’s irrevocable permission and consent that PTA may display, copy, reproduce, enhance, print, sublicense, publish, distribute and create derivative works for PTA purposes. PTA is not responsible for lost or damaged entries. Submission of entry into the PTA Reflections program constitutes acceptance of all rules and conditions. I agree to this statement and the National PTA Reflections Official Rules by signing below.

2) If you are a student with St. Tammany, signing this form gives consent for SPECIAL RELEASE OF STUDENT INFORMATION. The collection and maintenance of a student’s personally identifiable information requires special care to ensure the privacy rights of students and compliance with legal requirements governing these records, including the Family Educational Rights and Privacy Act (FERPA) and LRS 17:3914. The St. Tammany Parish School Board will maintain student records and personally identifiable information as confidential and will use reasonable commercially available steps to maintain as such. St. Tammany Parish School Board will follow all local, state and federal data security laws and policies and only share the data that is required for the purpose stated. Your student has elected to participate in the Louisiana PTA and National PTA Reflections Contest. One of the requirements for this activity is the use and release of student information to Louisiana PTA and National PTA as part of their participation which includes: complete name, student's submission, address and phone number, grade level, age, teacher, and school. By signing below, I, as the legal guardian, consent to the release and use by St. Tammany Parish School Board of my child’s personally identifiable information to any person or entity providing services to St. Tammany Parish School Board for this activity and who requires my child’s personally identifiable information in order to perform those services.

Student Signature*

Parent Signature*

Grade Division (Check One)*

Primary (Pre-K-Grade 2)Intermediate Grades 3-5Middle School (Grades 6-8)High School (Grades 9-12)Accessible Arts (All grades for students with a 504/ADA/IDEA)

Arts Category (Check One) - View guidelines for each category at LouisianaPTA.org/students.*

Title of Work*

DETAILS If background music is used in dance/film, citation is required. Include word count for literature. List musician(s) or instrumentation for music. List dimensions for photography/visual arts. Describe technology/platforms used in the creation process, including any generative elements.*

Artist Statement (In 10 to 100 words, describe your work and how it relates to the theme. The Artist Statement is 40% of the judging total for your entry.*

Entry Upload*

All entries must be submitted as a digital file. Please review the Arts Category guidelines for specific guidance on entry size/length and acceptable digital platforms at LouisianaPTA.org/students. Literature entries are submitted as PDFs.

Questions? Email President@LagniappePTSA.org.