Each Local Unit Can Submit 1 Special Artist Per Category for a Total of 35 Entries

Local to Council or Region Reflections Submission Form Theme: “Within Reach” 2017 The following information is required from all local PTAs participating in the Reflections Program. Please complete this form and forward it with your Reflections Program entries to the next level of judging. This form documents the number of entries submitted to the Reflections Program at the local PTA level. Please provide all of the information requested. This form is to be completed by your local PTA Reflections chair and forwarded with entry lists to the council level.

PTA Name: PTA ID # PTA Address: City, Zip PTA President: Email & Phone #

Reflections Chair: Email & Phone # Council you are in: Region #

Total Number of Students in School: Total Number of Students participating in Reflections: Local Units may submit only 28 entries total, representing each age group (7 categories x 4 entries = 28) Each local unit can submit 1 special artist per category for a total of 35 entries. By Division, how many entries did your Local PTA receive in each of the following arts categories?

Dance Film Musical Visual Arts Visual Literature Photography Chorography Production Composition 2D Arts 3D Primary

Intermediate

Middle School

High School

Special Artist Total Category Entries

By Division, how many entries did your Local PTA advance to the next level in each of the following arts categories?

Dance Film Musical Visual Arts Visual Literature Photography Chorography Production Composition 2D Arts 3D Primary

Intermediate

Middle School

High School

Special Artist Total Category Entries Please send a digital copy to your council Reflections Chairman AND a copy of this completed form with your reflections entries to the council level for judging. Remember to keep a copy for your records.