Suffolk Region Reflections 2023/2024: I am Hopeful Because Collection Form (no google account)

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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.

The name and photo associated with your Google account will be recorded when you upload files and submit this form. Any files that are uploaded will be shared outside of the organization they belong to.

Email *

School Name

Local PTA Unit Name*
*

Local PTA Unit NYS ID (on blaws cover page)

*

Local PTA Unit National ID (on bylaws cover page)
*

Local PTA Reflections Chair Name*
*

Local PTA Reflections Chair Email*

Is your Local PTA Unit in Good Standing?*
*

Yes

Is your Local PTA Unit registered to participate in Reflections?*

Yes

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Grade Division (choose one) *

Primary (Pre-K-Grade 2)

Intermediate (Grades 3-5)

Middle School (Grades 6-8)

High School (Grades 9-12)

Special Artist (All Grades)

Art Category (choose one) *

Dance Choreography

Film Production

Literature

Music Composition

Photography

Visual Arts

Student Name *

Grade

Age

Student Address (Street, City, Zip) *

Student Phone Number *

Parent Name (Last Name, First Name)
*

Parent Home Address

Parent Email *

Parent Contact Number *

Title of Work (Please make sure the file name matches the title of work.) *

Artist Statement (In 10 to 100 words, describe your work and how it relates to the theme)

Details (If background music is used in dance/film, the citation is required. Include a word count for literature. List musician(s) or instrumentation for music. List dimensions for photography/visual arts.) *

You must email all entries with identifying student information and as well as completed and signed Student Entry Forms to Reflections@suffolkregion.org.

I understand and will email the art file(s) and student entry form.

I do not understand and require assistance.

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Send me a copy of my responses.

Submit

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