National Pta Reflections Program Wilson Middle School Student Entry Form printable pdf download

National PTA Reflections Program

Wilson Middle School Student Entry Form

“The Magic of a Moment”

This informal Student Entry form is only for use by students entering the

National PTA Reflections Program at our school.

Grade Level/Division (Check one):

Arts Category (Check one):

 Middle School (Grades 6-8)

 Dance Choreography

 Special Artist (All grades)

 Film Production

 Literature

 Music Composition

 Photography

 Visual Arts

What is the Title of your work?_______________________________________________________

Please provide your Artist Statement here. How does your work relate to the

Reflections theme? Explain your work. (10 word minimum/100 word maximum)

_____________________________________________________________________________________

Student First Name: ________________________ Student Last Name______________________

Student Address: ____________________________________________________________________

Parent Phone Number: ______________________ Parent Email: _________________________

Home Room Teacher: ________________________

To be completed by Local PTA/PTSA

Full and Official PTA/PTSA Name: Wilson Middle School PTSA

Wilson Middle School PTSA Local PTA/PTSA 8-digit ID:

PTA/PTSA Contact Name: Fumiyo Araki Guzman

PTA Contact Phone: 818-543-0251

National Pta Reflections Program Wilson Middle School Student Entry Form