Unleash Your Strengths Photo Campaign

Thank you for agreeing to participate in the Unleash Your Strengths Photo Campaign! Please complete the form below and we will contact you with further details about taking your head shot, your strengths photo, and using your testimonial.

Question Title

* 1. What is your first name?

Question Title

* 2. What is your last name?

Question Title

* 3. What is your email?

Question Title

* 4. Department

Question Title

* 5. Degree 

Question Title

* 6. Please share which of your Top 5 strengths you use in your academic and/or professional life. (For example, help us to see your strength in action by describing how it helps your communication, teamwork, leadership, public health practice, or academics.) How has your strength enabled your path to public health? How does your strength assist to make the community / planet healthier?

For examples of testimonials, please review your Strengths Action Planning Guide in your Gallup Dashboard.

Question Title

* 7. Please select all of the following times you are available to take your professional headshot.

Question Title

* 8. I authorize the Regents of the University of California and their appointed agents to photograph, televise, videotape, film, audio record, duplicate, and/or transfer to any present or future technology, material from my appearance and agree that the Regents of the University of California, their authorized agents, employees and assignees may use the videotapes, photographs, film and/or audio recordings prepared therefrom for UCLA educational and marketing purposes. No “for profit” use of the images is intended or will be authorized. Photos may be manipulated or retouched. No compensation will be paid for this express use.

T