Participate Form

A1) Contribute a Virtual Memento

Contribute a story, a name, a poem, a photo, a drawing, an emoji, a video, an audio, a podcast, a tag, a hashtag or anything else that you feel honors your loss – click to expand form.

Title of the memento:

Type or copy/paste the title of your virtual contribution as it will appear on this website.

Virtual memento:

To submit the story as a document (PDF), do so in the the following field “Visual memento:”.

Visual memento:

Contribute an image (e.g. photo, drawing, etc.) or upload your story as a document (PDF).

File name:

File size:

A2) Share a Rich Media Memento (optional):

For rich media – audio/video, podcasts, etc. contribution , please read the “Rich Media Guidelines” and provide a link to hosted site (YouTube, Vimeo, Apple podcasts, etc.) – click to expand form.

Rich Media / Audio & Video Guidelines (Media)

The Media must be stored on publicly hosted sites such as Vimeo, YouTube, Apple, etc. You must provide a URL to the Media’s location. You must be the creator or have permission to share the Media by either the creator and/or hosting service. The Media must be free and unencumbered by other “to view requirements”. The Media must be advertising free including no in-media paid promotions, or end of the Media suggestions e.g. “hear/view more”.

Usage Rights

PAHU will not publish any commercial Media under copyright. By submitting the link of the Media to this project, as the Owner of said Media or has permission to share the Media, attests that to the best of their knowledge the Media does not contain copyrighted content. Failure to meet these requirements will result in the removal of the Media’s link(s) from this website and future printed publications.

Title or description of the media:

Type or copy/paste the title and/or description of your media contribution as it will appear on this website.

Rich media / audio & video link:

Provide a link to the file from the hosting site (YouTube, Vimeo, Apple podcasts, etc.).

B) Associate Topics and Hashtags to your memento:

To assist in cataloging the contributions on this website, please select all topics and hashtags relevant to your story, photo, and virtual donations.

Topics:

Please check all those that apply. Additional terms may be found under hashtags below. Suggest additional topic terms if missing.

Topics to add:

Hashtags:

Please check all those that apply. Suggest additional hashtag terms if missing.

Hashtags to add:

C) Associate your name and/or names to the memento (optional):

To enter name(s) associated with the physical or virtual memento – click to expand form.

Name(s):

For multiple names, comma separated e.g. Mother’s Name, Father’s Name, Your Name

Note about names:

If supplying an email address (below) and multiple names supplied above, identify the person associated with the email.

For additional information about the individual(s) above not conveyed in the memento, title, image, etc.: Multiple names separated by period or semi-colon, and data separated by comma.

Email (optional):

Email will not be public. Only one address.

Phone (optional):

Phone number will not be public.

Please read before submitting

1) Disclaimer

Participation in this project is voluntary. Donations of physical memento(s) are not returnable. If provided by you or a designated representative, your name will be publicly listed with your story and/or physical memento. You may have to reflect on sharing personal information. There are no direct benefits for taking part in this project. However, we hope the stories we gather through this public art project provides an opportunity for individuals to share their personal loss and grief and help develop a greater understanding of the impact of COVID-19.

2) HIPPA and Patient Confidentiality Policy

The PAHU wish to respect the confidentiality and legally-protected health information of any patient featured in an essay, story, poem, image, or multimedia (containing audio, video, and/or other components) Work published in artheals.utah.edu. The Owner must abide by all relevant local, state, and federal regulations regarding patient confidentiality. Owners must ensure that if a patient is identifiable — including by him/herself — a written statement of consent to publication signed by that patient is provided to the PAHU. The patient should be shown the Work before publication. If the Owner prefers to de-identify a patient, special attention should be paid to potentially identifying characteristics. Given the pool of contributors and audience of PAHU, patients described are likely to be receiving treatment at the University of Utah Hospital or associated facilities. A patient with a rare or unusual health condition or treatment process may be easily identifiable by some artheals.utah.edu readers even if names and other obvious identifying factors are removed. If in doubt, please consult with the PAHU and/or faculty advisor. The artheals.utah.edu reserves the right to decline publication of any Work that violates these guidelines.

3) Publishing Agreement

The University of Utah, through its station PBS Utah or through its University of Utah Health, Spencer S. Eccles Health Sciences Library (EHSL), Project Art Heals Utah (PAHU) or through another of its departments or operating units (collectively, “University”), intends to create a public art work and digital collection that includes photographs, narratives, objects or other creative works documenting community-members’ loss from the COVID-19 pandemic.

I hereby consent to and authorize the University to use, without compensation to me, the copyrightable work that I am submitting in connection with this Agreement in the Project Art Heals Utah (the “Work”).

The University and its agents and licensees shall have the non-exclusive right to publish, reproduce, exhibit, broadcast, distribute (including via television, radio, internet platforms), display, make available for download, or otherwise use the Work. The University will provide proper attribution to me, if provided by me, in its exercise of the rights granted herein.

The rights described herein are irrevocable, worldwide and perpetual. The University is not obligated to exercise any of the rights granted herein. The rights granted herein shall survive any and all assignments of copyright from me to another owner.

I hereby release, discharge, and covenant not to sue the University, its agents, successors, and assigns from any and all claims arising out of or in connection with the use of the Work, including but not limited to any claims of defamation or invasion of privacy.

I represent and warrant that I am, or the minor child named below is, the sole and exclusive owner of the copyright in and to the Work and that I have the full right and authority to grant the rights herein granted, and that the rights granted herein shall not infringe upon any copyright or any other right of any third party.

If the Work is submitted as part of an academic assignment, I acknowledge that publication of the Work may disclose participation in a class or other educational activity and is generally protected from disclosure by the Family Educational Rights and Privacy Act (“FERPA”). By signing this Agreement, I am expressly consenting to the public release of this FERPA protected information.

Minor Participants:

Check if your the parent or legal guardian of a minor participant(s).

Minor Participants

Minor Participants Full Name: *

I am the parent or legal guardian of the named in the following field, and am authorized to grant the rights and provide the releases contained herein for the MINOR CHILD/CHILDREN.

Parent/Guardian’s Name(s): *

Type your name to confirm the minors participation. For multiple names, comma separated e.g Mother, Father

Parent/Guardian’s Phone Number: *

Type 10-digit phone number.

ACCEPTED AND AGREED *

*Required

By clicking the submit button, you have read the above documents and are providing consent and permission for your story and/or name to be published publicly. Your stories and virtual memento contributions are not guaranteed to be published. Items will be reviewed and subject to approval by the Project Art Heals Utah (PAHU) and/or designated associates.

On Instagram

Sponsors

Site development, hosting, maintenance by Eccles Health Sciences Library