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
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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