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Executive Board
New and Returning Officers Form
Please complete as much information as possible beyond the required data below.
Unit Information
Full Name of PTA/PTSA
*
National PTA Local Unit Number
*
Federal EIN Number
*
School Information
Principal's Name
*
First
Last
Type of School
*
Elementary
Junior/Middle
High School
Other
Total School Enrollment (as of 9/30/2015)
*
PTA Officer's Information
President's Name
*
First
Last
President's Home Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
President's Email
*
President's Preferred Phone
*
President's Secondary Phone
*
Treasurer's Name
*
First
Last
Treasurer's Home Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Treasurer's Email
*
Treasurer's Preferred Phone
*
Treasurer's Secondary Phone
*
Secretary's Name
*
First
Last
Secretary's Home Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Secretary's Email
*
Secretary's Preferred Phone
*
Secretary's Secondary Phone
*
First VP's Name
*
First
Last
First VP's Home Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
First VP's Email
*
First VP's Preferred Phone
*
Second VP's Name
*
First
Last
Second VP's Home Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Second VP's Email
*
Second VP's Preferred Phone
*
Membership Chair Name
*
First
Last
Membership Chair Email
*
Membership Chair Phone
*
Legislation Chair Name
*
First
Last
Legislation Chair Email
*
Legislation Chair Phone
*
Reflections Chair Name
*
First
Last
Reflections Chair Email
*
Reflections Chair Phone
*
By providing email addresses, PCCPTA can provide important update to each member listed. PCCPTA uses this information for its communication purposes only.
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