2024-2025 State Network Enrollment Form

Thank you for completing this form to verify your information as a State Reflections Chair. As a member of National PTA's State Reflections Network, you will be connected to other state-level Reflections leaders and receive support, training opportunities and the latest updates from National PTA.

If you have completed this form in a previous program cycle, please submit at least your contact information to ensure that you stay in the loop on Reflections news.

An asterisk(*) shows questions that require a response.

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* 1. First Name

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* 2. Last Name

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* 3. Title

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* 4. Email

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* 5. Phone Number

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* 6. State

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* 7. My race/ethnicity is:

Prefer to self-describe.

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* 8. My gender is:

Prefer to self-describe.

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* 9. About how many years have you served as a State Reflections leader?

This is my first year as a State Reflections Chair.

Less than one year

1 - 3 years

3 or more years

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* 10. What do you hope to gain from joining National PTA's State Reflections Network (Check all that apply)?

Networking opportunities with State Reflections leaders

Access to National PTA updates and reminders

Access to training and shared learning opportunities

Access to Reflections resources and materials

Other (please specify)

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* 11. What is the reason why you volunteered to host Reflections for your state (Check all that apply)?

I believe my child is worth the extra effort.

I have fun volunteering with PTA.

I have time, talent or skills to offer.

I want schools and students to feel supported.

I have interest in the arts.

I have interested in increasing access to the arts in education.

Other (please specify)

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* 12. Why is the Reflections program important to you?

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* 13. Would you like to answer a few more questions to complete your state PTA's registration for the 2024-2025 "Accepting Imperfection" Reflections program?

Yes, I would like to register my state PTA's participation in Reflections.

No, I will register my state PTA's Reflections participation in Reflections at another time.

Please note: You may also register at a later date through the general Reflections registration form available at PTA.org/Reflections.