Application for PTO Parent Representative on a Site Base Member Team
Name______________________________________Phone (day) _________________
Phone (evening) ______________
Address_____________________________________
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1) Number of years as a PTO member ______
2) I wish to be a member of the __ Elementary __ Middle __ High School SBMT.
(You may apply for more than one team, but may serve on only one.
Please remember that you must have a child enrolled in the school that you serve.)
Children’s Names Grade
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3) Have you previously served on a SBMT or Ad-Hoc Committee? ___
If yes, which team(s)/committee(s) __________________________
From __________ to ____________
4) Please tell us about any interests, community involvement, education or work experience you may have that you believe will help make you an asset to the SBMT.
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5) Please tell us why you desire to be a member of a Mount Sinai SBMT and what you believe you can contribute through your involvement.
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