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Reflections Student Entry Form
Arkansas PTA Reflections Program Student Entry Form
2018-2019 Theme: “Heroes Around Me"
State Reflections Entries are Due by January 15, 2019. Online submissions require a Google based platform, so a Gmail account will be required to submit.
Student's Street Address
Student's City, State and Zip Code
Parent/Guardian Information: email
Parent/Guardian Information: phone number with area code
Student's Grade Level (check one)
Primary (Preschool – Grade 2)
Intermediate (Grades 3-5)
Middle School (Grades 6-8)
High School (Grades 9-12)
Special Artist (All grades)
Local PTA Name
Local PTA City
Local PTA Chairperson's Name
Local PTA Chairperson's Contact Phone Number or Email
Local PTA President's Name
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