New and Returning Officers

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 *

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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