STUDENT COMMUNITY SERVICE AWARD

MISSION-VISION: Participatory-Recognition
A PTA must submit an application for a particular group of students, five or more, who have participated in a community service project that they feel is worthy of notice. The group of students does not need to be affiliated directly with the school or PTA applying on their behalf. DEADLINE: MAY 1st
Membership dues must have already been paid prior to the submission of this application. DEADLINE to apply: May 1, 2017
Full Name of PTA/PTSA(*)
Please type your full name.

(As listed on your Bylaws - No abbreviations)

County(*)
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National PTA Local Unit Number:(*)
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Bylaws must be current to receive this award.
Enter the Bylaws Approved Date below.
Bylaws Approval Date(*)

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NAME OF PROJECT
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ONE TIME OR ONGOING?
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DATE OF SERVICE(*)

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Description of Service
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UPLOAD ADDITIONAL DOCUMENTS IF NECESSARY
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UPLOAD ADDITIONAL DOCUMENTS IF NECESSARY

Number of Participants(*)
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Number of Service HOURS(*)
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Name of PTA(*)
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PTA Address(*)
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PTA Phone Number(*)
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Principal's Last Name(*)
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Principal's First Name(*)
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President's Last Name(*)
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President's First Name(*)
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President's Home/Cell Phone(*)
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Please provide a phone number where you can be reached after hours or during the summer if needed.

President's Home Address(*)
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President's Email(*)
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Applicant's Last Name(*)
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Applicant's First Name(*)
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Applicant's Email(*)
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Applicant's Title or Position(*)
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Certification(*)
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