Cover Submittal Form for Local Unit Membership Report

Date

Colorado PTA Region

Council

Student Population (i.e. K-5, 6-8, K-12, PK, etc.):

District:

Type School:
PublicPrivateCharterEarly Childhood

PTA/PTSA Unit Name

PTA/PTSA Address / Zip

Name of Membership Chair (or President, if applicable)

Home Address / Zip

Home Phone

E-mail

Total number of full time Staff at school

Total Student enrollment this year

Number of new Parent members on this report

Number of new Staff members on this report (Includes all full time certified and classified personnel) year

Number of new Community members on this report

Number of new Student members on this report

Number of new Individual Memberships this report

x $ 6.25 = $

Number of new Business Partners this report

x $10.00 = $

ENCLOSED [TOTAL 1 + 2] = $

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