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Local PTA Information
LOCAL PTA
Walt Disney Elementary
NATIONAL PTA ID
006789
LOCAL PROGRAM CHAIR
Christina Cervantes Williamson
EMAIL
example@example.com
STUDENT NAME
GRADE AGE
PARENT/GUARDIAN NAME(S)
EMAIL
example@example.com
PHONE
Format: (000) 000-0000.
MAILING ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ownership in any submission shall remain the property of the entrant, but entry into this program constitutes entrant's irrevocable permission and consent that PTA may display, copy, reproduce, enhance, print, sublicense, publish, distribute and create derivative works for PTA purposes. PTA is not responsible for lost or damaged entries. Submission of entry into the PTA Reflections program constitutes acceptance of all rules and conditions. I agree to the above statement and the National PTA Reflections Official Rules. Signatures (typed or handwritten) are required for all entries.
STUDENT SIGNATURE (Required for all entries)
*
PARENT/GUARDIAN SIGNATURE (Required for all entries)
*
Local PTA Information
Rows
GRADE DIVISION (Check one)
ARTS CATEGORY (Check one)
ARTS CATEGORY (Check one)
CATEGORY AND DIVISION (All entrants must select a grade-level division and arts category.)
GRADE DIVISION (Check one)
PRIMARY (PreK-Grade 2)
INTERMEDIATE (Grades 3-5)
MIDDLE SCHOOL (Grades 6-8)
HIGH SCHOOL (Grades 9-12)
ARTS CATEGORY (Check one)
DANCE CHOREOGRAPHY
FILM PRODUCTION
LITERATURE
MUSIC COMPOSITION
PHOTOGRAPHY
VISUAL ARTS
ACCESSIBLE ARTS DIVISION PARTICIPATION
Students who identify as having a disability and may receive services under IDEA or ADA: Section 504 may also select to participate in the Accessible Arts Division to receive division-specific accommodations and non-artistic accommodations as outlined in the division guidelines. Participating students may use the "Additional Details" field to provide information about how their disability and/or support needs impacted their entry (10 to 100 words, optional). Participating students compete against other students in the division and are awarded as part of the division. See division guidelines for details.
I will participate and compete in the Accessible Arts Division.
I will NOT participate and compete in the Accessible Arts Division.
ARTWORK DETAILS (As relevant or required based arts category and/or division)
Medium and Materials (Visual Arts)
Dimensions (Visual Arts/ Photog.)
Word Count (Lit.)
Editing software, if used. (All categories)
Cite background music, if used. (Dance/Film)
List musician(s) or instrumentation (Music)
PTA Reflections Program Student Entry Packet | Page 3
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TITLE (Required for all entries)
*
ARTIST STATEMENT (Required for all entries) In 10 to 100 words, describe your work and how it relates to the theme.
*
ADDITIONAL DETAILS If technology is used, describe the platform's use in the creation process, including any generative elements (required for all entries, 10 to 50 words). Students participating in the Accessible Arts Division may provide details about how their disability and/or support needs impacted their entry (Optional, 10 to 100 words).
*
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