Foundation for Springfield Public Schools

“What I’ve Learned So Far: The Next

Generation”
Student Submission Form
Deadline to Submit: October 18, 2010

The Foundation for Springfield Public Schools is celebrating its 20th

Anniversary with the second edition of the book published by the Foundation
nearly 20 years ago, “What I’ve Learned So Far.” The Next Generation will
represent what students have learned so far about school, life, fun, family
and everything in between.
The Rules: Each student in Springfield Public Schools may submit one entry,
including the media release complete with a parent or guardian signature.
Entries to be published in the book will be chosen by an independent editing
panel of teachers, professionals, volunteers and community members. If you
have questions regarding this project contact Natalie Murdock at the
Foundation for Springfield Public Schools at 523-0030 or
nmurdock@spsmail.org or Jana Bachus, Foundation Board Member at
jababba@sbcglobal.net.

Student Name: _______________________________ Student Age: ________

School: ____________________________________ Grade Level: ________
Now tell us,
What Have You Learned So Far?

Media Release
I hereby give my permission to the Foundation for Springfield Public Schools to use
___________________ (student’s name) name, school, age/grade and submission in print in the
book “What I’ve Learned So Far: The Next Generation.” I agree to participate in this project
without compensation of any character. I understand that this releases the Foundation for
Springfield Public Schools from any claims including but not limited to liability, arising from
the use of this material. I agree that the Foundation for Springfield Public Schools can use
the student’s full name unless otherwise requested in writing by the parent/guardian to refer
to the student by partial name or initials.

I agree that the Foundation for Springfield Public Schools may use the information above for
any lawful purpose, including, but not limited to, for example such purposes as publicity,
illustration, advertising, and Web content.

I have read and understand the above (Please Print):

Student Name: _________________________________________
Parent or Guardian Name: ________________________________
Address: ______________________________________________
City, State Zip: _________________________________________Phone/e-mail: ____________________
Parent or Guardian Signature: _____________________________ Date: _________________________
Please complete this information and return to the Foundation for Springfield
Public Schools, 3002 W. Kildee Lane, Springfield, MO 65810.