Professional Bulletin Portraits

 

If you are a social worker in the state of Oregon, please contact Pam Stanley with Oregon DHS at pam.stanley@state.or.us for the correct Photo/Heart Gallery Referral Form. If you are a social worker in any other state, please fill out the Professional Bulletin Portraits form below. If you would like to have photos done for any other reason than recruitment(for example: senior photos, sibling photos, lifebook photos, etc), please specify in the reason box (below) or contact photos@afamilyforeverychild.org .

To: Photography Coordinator
A Family For Every Child
Office: (541) 343-2856
*Social worker First name
*Last
Email
*Phone
Address
City
*County
*State
Zip
How Many Children
If these children have a case number already assigned, please indicate the number below.
Child(ren)'s City of Residence

*Child(ren)'s County
*Child(ren)'s State
Other person responsible for setting up the photo session
Contact for responsible person

First Name
Last Name
Email
Phone
Dates available for scheduling purposes



What are you requesting photos for?

Photo Contact Information

If you are applying your child(ren) for the Heart Gallery, fill this section out as well.



Children's Legal Status
Social Worker's Branch
Supervisor's First Name
Supervisor's Last Name
Supervisor's Phone
Supervisor's Email
Foster Parent's First Name
Foster Parent's Last Name
Foster Parent's Phone
Foster Parent's Email
Foster Parent's Address
Foster Parent's City
Foster Parent's State


Restrictions:

Should a pseudonym be used on the child's picture?


Are there areas of the state the child's portrait should not be displayed?
,

Please don't feature the child in the following locations:

Are there any sensitivities we should be aware of when taking photos?


If the Child has a CASA or an attorney,
please provide the following information in case
the Heart Gallery would like more information for the description:
CASA Name (first, last), Phone
Attorney Name (first, last), Phone


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