Share Your Story with the Education Fund

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First Name*

Last Name*

Phone Number*

Email*

Employee ID Number

Current Job Title

Employer

Facility

Department

Please choose your Union from the dropdown menu.

Please choose your Region from the dropdown menu.

Choose from the dropdown list which Education Fund program/service did you use:

Choose from the dropdown menu if you used a second Education Fund program/service:

What are your career goals? (Example: To improve your finances, to make your current job better, to change careers — please describe in detail)*

Please describe what you have achieved so far towards your career goals?*

Which of the Education Fund programs, classes or support have helped you achieve these goals?*

How have the benefits you received through the Education Fund helped you and/or your family?*

Please choose from the dropdown menu which Education Fund staff member you've been working with while participating in the Ed Fund.

What would you tell a coworker about using their Education Fund benefits?*

What are the next steps in your career?*

Anything else to add?

Photo

Thank you for sharing your experience with us! We like to highlight learner achievements in our materials and to include pictures when possible.

If you can provide a photo that we can use, please upload your picture here, and sign the consent below.

Please upload a picture of yourself that may be used within a member newsletter, presentations to our trustees and/or employers, or as part of our publicity campaigns.

Max. file size: 25 MB.

Media Release and Consent Form

This form gives the Education Fund and its affiliated nonprofit organization Shirley Ware Education Center, permission to use your photo/video and your quotes in our materials including: email newsletters, postcards, presentations to trustees or employers, website, social media or elsewhere to help encourage other members to use Education Fund services. We may also need to contact you for follow-up purposes.

I, the undersigned hereby irrevocably consent to the unrestricted use of all photographs and videos depicting my image for use by and for the SEIU-UHW West & Joint Employer Education Fund and the Shirley Ware Education Center (hereafter referred to as the Education Fund/SWEC) and any images created therefrom. I also consent to the use of comments and quotes, written or verbal, I have provided about my experiences related to the Education Fund/SWEC, it’s programs and services, and any related matters.

Scope of Consent

The Education Fund/SWEC may use my name and such photographs and images and comments I have given for any and all purposes, including: art, advertising, promotional, education and web, and in all media including electronic, video, digital and print media, without further compensation to me. I certify that I am not a minor and am free and able to give such consent. Waiver. I waive any right to approve: 1) the finished photographs/videos, images or printed matter that may be used in connection with my name or the photograph/videos taken of me; and 2) the eventual use of any of the foregoing.

I acknowledge that the Education Fund/SWEC owns all rights to these photographs and images, and I waive any claims that I have or may have based on their usage of the photographs or works derived therefrom. Release. I hereby release and hold harmless the Education Fund/SWEC, its staff or agents, related content creators and photographers, videographers and interviewers from all damages and liability that may arise from or in connection with the use of my name, my comments and quotes, the photographs taken of me, or the images created therefrom.

Entire Agreement

This agreement constitutes the sole agreement between the Education Fund/SWEC and myself regarding my modeling services and I am not relying on any other oral or written representation made by the Education Fund.

Acknowledgment of Media Consent

Please acknowledge and accept the above by typing your name above and sign your name below to agree.

Signature

Education Fund Experience Form

Photo

Media Release and Consent Form

Scope of Consent

Entire Agreement