1.Contact Information

First Name

Last Name

Personal Email Address

Phone Number

Mobile Phone

2.Job / Worksite Information

Job Classification

Worksite

Employee or Union ID Number

3.What are the key things you are responsible for at your school site?

*4.How many hours are you paid for as a Community Representative?(Required.)

1-3 hours

4-6 hours

More than 7 hours

*5.Do you work more hours as a Community Representative than you are paid for?(Required.)

Yes, I work 1-3 extra hours that I am not paid for.

Yes, I work 4 or more extra hours that I am  not paid for. 

No

6.Please share any other thoughts or experiences to illustrate the need for fair and respectful treatment at work. For example, do you feel you could question a principal or teacher regarding an issue that affected the parents and families you work with? 

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