Permission to Include Student Work and Images in a Professional Teaching Portfolio

Dear Parent / Guardian

I, Ms. Amber Mackintosh, am creating/updating my Professional Teaching Portfolio to demonstrate my growth, achievements, and experiences
while teaching. Typical portfolio items include photographs of successful teaching moments, creative projects, or samples of student work.
My Professional Teaching Portfolio is online and is for my professional use only. Students limited identifying information (first name, grade,
photo of students or their work) may appear on the materials, but my portfolio will only be shared with persons associated with my teaching
career and professional development to highlight my progress and accomplishments in the teaching profession.
Please complete the form below to indicate approval for the use of your childs schoolwork and/or images in my Professional Teaching
Portfolio.
Sincerely:
Ms. Amber Mackintosh

_____________________________________________

(Teachers Name - Please Print)

(Teachers Signature)

(To be completed by the parents/legal guardians of a minor student)

Students Name: ____________________________________

Grade: _____________________________________

School: ___________________________________________

Teacher: Ms. Amber Mackintosh

As the parent/legal guardian of the child named above, please check one of the following options:
I DO give permission for the teacher named above to include any materials my child produces as part of classroom activities in
the teachers Professional Portfolio, in accordance with copyright regulations. I understand that limited identifying information may
appear on the materials in the teachers portfolio.
I DO NOT give permission for the teacher named above to include any limited identifying information of my child or any materials
my child produces as part of classroom activities in the teachers Professional Portfolio.
Print Name of Parent or Guardian:

_________________________________________

Signature of Parent or Guardian:

_________________________________________ Date: _________________________

If this form is not completed and returned to the school it will be considered that you have not provided consent to
use your childs work samples and photographic images as described above
The information on this form is collected in accordance with the Freedom of Information and Protection of Privacy Act, Sections 33, 34, 38, 39,
40 and 41.