2012 Keystone STARS Shining Stars Nomination Form Deadline: March 9, 2012page 1
Help us celebrate 10 years of Shining Stars!
Nominate a child for recognition today!
Nominations due: March 9, 2012
Over the past 10 years, thousands of children have participated in Keystone STARS programs throughout the state. For some, this experience meant a safe and nurturing place to grow, for others, a place to address and overcome delays. For all children, participating in quality early education through Keystone STARS is helping them become the Shining Stars they deserve to be!
Help recognize some of the Shining Stars in your community.Pennsylvania’s Promise for Children and your Local Education and Resource Network (LEARN) team are collecting stories from families and children who have participated in a Keystone STARS program about what that experience has meant to them and how Keystone STARS has helped them reach their promise.
Who is eligible to be a Shining Star?
Any child who has participated in a Keystone STARS program (at STAR 2 level or higher)for at least two years is eligible to be recognized as a Shining Star. The child may be a “graduate” of the program.The program should currently hold a STAR 2-4 rating even if the child has graduated.
Who can nominate a Shining Star?
- Children can nominate themselves (with their parent’s or guardian’s permission)
- Families of children
- Teachers and program directors (with permission from the child’sparent or guardian)
How do I nominate a Shining Star?
Complete the attached nomination form, including a short essay or video essay about how participating in a Keystone STARS program has made a difference in the child’s and family’s lives. The essay may be completed by the child or the individual nominating the child. Children may also include artwork with the essay. Essays and photos/videos of the Shining Stars will be made public, so permissions from the child’s parent/guardian must also be included. All nominations will be reviewed for appropriate language and content before being published; incomplete or inappropriate nominations will not be recognized or published.
Nominees will be recognized locally and in Harrisburg.
Your Shining Star nominees will be recognized locally in April and invited to participate in a recognition and family fun day in Harrisburg on May 8, 2012. The day will kick off at the Whitaker Center with a press event. After the event, nominees and their families will have free access to Harrisburg attractions.*
Nominees’ stories will be shared with families and communities across Pennsylvania on the Pennsylvania’s Promise for Children’s website and local LEARN websites. Nominees may also be highlighted in local newsletters and news stories.
For more information, contact your local LEARN team coordinator at 610-685-4577or visit
2012 Keystone STARS Shining Stars Nomination Form
Please submit by March 9, 2012 to your Local Education and Resource Network (LEARN) team at
- Email: r fax: 610-685-4569
- Signed release can be faxed/emailed by deadline, but then should also be mailed to
United Way of Berks County
Attention: Jane Moyer
P.O. Box 702
Reading PA 19603-0702
- Questions? ContactJane Moyer at 610-685-4577
- You can also submit your nomination online at
Nominations must include
Nomination form
Signed Photo/video waiver form
Photo or video of the child- can also include the rest of the family and/or teachers from the program
Essay or video essay about how participating in a Keystone STARS program has made a difference in the child’s and family’s lives. The essay may be completed by the child or the individual nominating the child. Children may also include artwork with the essay. (If you are submitting video, the preferred format is .mp4)
Name of individual nominating the Shining Star: ______
Relationship to nominee:______
Phone:______Email (required):______
I would like to nominate the following child as a Shining Star:
Name of Child:______Age: ______
Name of parent or guardian: ______
Address: ______
City: ______County: ______
Phone:______Email (required):______
Name of Keystone STARS program that the child participates/participated in: ______
STAR level of the program:______
Dates that the child is/was enrolled in the program: from ______to ______.
Risk factors that impact the child:
2012 Keystone STARS Shining Stars Nomination Form Deadline: March 9, 2012page 1
Living in economically at-risk families (up to 300% of poverty)
English Language Learners
Has disability and/or developmental delay
Mother has less than a high school education
Born premature or with low birth weight
Other:
2012 Keystone STARS Shining Stars Nomination Form Deadline: March 9, 2012page 1
All nominations will be reviewed for appropriate language and content before being published; incomplete or inappropriate nominations will not be recognized or published.
Why is this child a Shining Star to you?
Essay: Please share in 500 words or less (or a video of 5 minutes or less) how participating in a Keystone STARS program has helped you/this child become a Shining Star. You may use a separate sheet to complete your essay.For example:
- Was there a particular teacher that went out of his/her way to help this child grow?
- Did the child overcome delays or challenges because of the care of staff and quality of activities?
- What is special about this program that helped this child reach his/her promise? If the program joined STARS or earned higher STAR levels while this child was attending, what changes or improvements did you notice?
- How has the child developed as a result of the quality early education he/she received from this program?
- How has the family been involved? Did the program and teacher support the family’s involvement in the child’s early learning?
- You may want to share an example of skills the child has learned while participating in the program that perhaps he/she struggled with when first entering the program.
The child may write the essay, or provide artwork in addition to the essay.
Parent Photo/Video Waiver Form
- Must be signed by child’s official parent or guardian.
- Parent/Guardian: please complete and sign below. Please include a photo or video of the child (may also include the family or teacher)
The name and city of the STARS program that the child attended may be used in public materials. (ex., John S. attended Child Care program, a STAR 3 program in Harrisburg, PA)
Please indicate how you would like your child’s name to appear on public materials. (check one):
The child’s first name and last initial (ex. John S.)
The child’s first and last name (ex. John Smith)
I hereby grant Berks County Intermediate Unit, the parent organization of Pennsylvania’s Promise for Children, its legal representatives and assigns, and those acting with its authority and permission, the absolute right and permission to copyright, use, reuse, publish, and republish, photographic portraits, pictures, or videos of
______
(name of child)
without restriction as to changes or alterations, or reproductions thereof in color or otherwise made through any media for art, advertising, trade, or any other purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith.
I hereby waive any right that I may have to inspect or approve the finished product or products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied.
I hereby release, discharge and agree to save harmless Berks County Intermediate Unit, its legal representatives or assigns, and all persons acting under its permission or authority, from any liability by virtue of any blurring, distortion, alteration, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said picture(s) or in any subsequent processing or manipulation thereof, as well as any publication thereof.
I hereby warrant that I am of legal age and have every right to contract in the above regard as parent or guardian for
______.
Name of child
______
Parent/Guardian’s Signature Date
______
______
Parent/Guardian’s Name and Address
Yes, my child and family plan to attend the Recognition event in Harrisburg on May 8, 2012.
Number of people planning to attend: _____
Nominees may receive up to four complimentary passes to Harrisburg attractions for themselves and their family.
Return with nomination form to:
Jane Moyer, United Way of Berks County
P.O. Box 702, Reading PA 19603-0702
Pennsylvania’s Promise for Children |