PHSC General Membership Form
The Philadelphia Home and School Council (PHSC) welcomes all Home and School Associations to the 2019 - 2020 school year.

All Associations are required to complete the online membership form, signature page and to pay dues annually in order to become a member and/or maintain membership with the PHSC.

Dues will remain at $150 for the academic school year and should be submitted to the Council within 90 days of the completion of the application via mail or hand delivery.

We require all of the information on the form to be completed in full. Once completed and submitted electronically to the office, but you will be prompted to print the Signature Page. Once you acquire all officer signatures the form must be submitted along with your Membership Dues.
Please note: The personal information required must be given, as that information is for insurance purposes, and in the event we need to personally contact any member of your HSA Executive Board.

Payments are to be made by check or money order payable to:
Philadelphia Home and School Council.

Philadelphia Home and School Council
440 N. Broad Street, Rm. 115
Philadelphia PA 19130

A viable Association must have a minimum of three (3) duly elected officers who must include the following:
One (1) President, One (1) Treasurer, One (1) Vice President or One (1) Recording Secretary

If you are a newly established HSA, the first event held should be a Membership Drive. This event will enable you to pay your dues.

If you are a returning HSA, your dues are to be sent in no later than October 31, 2019. This is to ensure your rights as a viable and sanctioned Association.

If you are having difficulties, please immediately notify Katrina Clark, and request their assistance.

May we have a successful, informative year of working together for all of our children!

Email address *
Association Information
School Name: *
Your answer
Name of Association: *
Your answer
Please indicate your Network? Click here for new Network assignment - https://apps1.philasd.org/onlinedirectory/regionList.jsp *
Is your school considered:
Are you a new Home and School Association?: *
Do you have Bylaws? If yes, a copy must be submitted with your Signature Page and Membership payment. You can also email a copy to phscvp1@gmail.com. If no, please note that Bylaws MUST be established for your HSA no later than October 31, 2019. Please contact us for support if needed.: *
Do you have an EIN #?: *
If yes, list your Home and School Association EIN #:
Your answer
Do you have a bank account?: *
If yes, what bank do you use?:
Your answer
Do you have checks associated with your account? *
Do you have a debit card attached to your HSA account? *
What email address is attached to the HSA bank account? *
Your answer
School Address: *
Your answer
School Telephone Number: *
Your answer
School Fax Number: *
Your answer
Principal of School: *
Your answer
Principal Email Address: *
Your answer
Do you have an HSA email address? *
What is your HSA email address? *
Your answer
Do you have social media account? If so, which ones? Please list your username so we can promote and follow: *
Required
List your Social Media Account Names:
Your answer
Officers' Information
It is very important that the following information be submitted with your membership application. Please complete fully.
Date when Home & School officers were elected to Office: *
Your answer
Have your officers been installed by PHSC?: *
Date when Home & School officers were installed:
Your answer
Is this an election year for your HSA - Fall 2019 or Spring 2020?: *
President's Information
(P) represent's "President"
(P) Name: *
First and Last
Your answer
(P) Home Address: *
Include zip code
Your answer
(P) Home Phone or Second Contact Number: *
Your answer
(P) Cellphone Number: *
Your answer
(P) Are you employed by the School District of Philadelphia?: *
(P) If yes, please list your title and school assignment.:
Your answer
(P) E-mail: *
Your answer
(P) Child/Children who attend this school: *
Your answer
(P) Select the grade(s) your child or children are in: *
Your answer
Vice President's Information
(VP) represent's "Vice President"
(VP) Name:
First and Last
Your answer
(VP) Home Address:
Include zip code
Your answer
(VP) Home Phone Number or Second Contact Number: *
Your answer
(VP) Cellphone Number:
Your answer
(VP) Are you employed by the School District of Philadelphia?:
(VP) If yes, please indicate your title and school assignment:
Your answer
(VP) E-mail:
Your answer
(VP) Child/Children who attend this school:
Your answer
(VP) Select the grade(s) your child or children are in:
Your answer
Second Vice President's Information
(VP2) represent's " Second Vice President"
(VP2) Name:
First and Last
Your answer
(VP2) Home Address:
Include zip code
Your answer
(VP2) Home Phone or Second Contact Number: *
Your answer
(VP2) Cellphone Number:
Your answer
(VP2) Are you employed by the School District of Philadelphia?:
(VP2) If yes, please indicate your title and school assignment: *
Your answer
(VP2) E-mail:
Your answer
(VP2) Child/Children who attend this school:
Your answer
(VP2) Select the grade(s) your child or children are in:
Your answer
Third Vice President's Information
(VP3) represent's " Third Vice President"
(VP3) Name:
First and Last
Your answer
(VP3) Home Address:
Include zip code
Your answer
(VP3) Home Phone or Second Contact Number: *
Your answer
(VP3) Cellphone Number:
Your answer
(VP3) Are you employed by the School District of Philadelphia?:
(VP3) If yes, please indicate your title and school assignment: *
Your answer
(VP3) E-mail:
Your answer
(VP3) Child/Children who attend this school:
Your answer
(VP3) Select the grade(s) your child or children are in:
Your answer
Fourth Vice President's Information
(VP4) represent's " Fourth Vice President"
(VP4) Name:
First and Last
Your answer
(VP4) Home Address:
Include zip code
Your answer
(VP4) Home Phone or Second Contact Number: *
Your answer
(VP4) Cellphone Number:
Your answer
(VP4) Are you employed by the School District of Philadelphia?:
(VP4) If yes, please indicate your title and school assignment: *
Your answer
(VP4) E-mail:
Your answer
(VP4) Child/Children who attend this school:
Your answer
(VP4) Select the grade(s) your child or children are in:
Your answer
Treasurer's Information
(T) represent's "Treasurer"
(T) Name: *
First and Last
Your answer
(T) Home Address: *
Include zip code
Your answer
(T) Home Phone or Second Contact Number: *
Your answer
(T) Cellphone Number: *
Your answer
(T) Are you employed by the School District of Philadelphia? (*The HSA Treasurer CANNOT be a SDP employee): *
(T) E-mail: *
Your answer
(T) Child/Children who attend this school: *
Your answer
(T) Select the grade(s) your child or children are in: *
Your answer
Recording Secretary's Information
(RS) represents "Recording Secretary"
(RS) Name:
First and Last
Your answer
(RS) Home Address:
Include zip code
Your answer
(RS) Home Phone or Second Contact Number: *
Your answer
(RS) Cellphone Number:
Your answer
(RS) Are you employed by the School District of Philadelphia?: *
(RS) If yes, please indicate your title and school assignment:
Your answer
(RS) E-mail: *
Your answer
(RS) Child/Children who attend this school:
Your answer
(RS) Indicate the grade(s) your child or children are in:
Your answer
Corresponding Secretary's Information
(CS) represents "Corresponding Secretary"
(CS) Name:
First and Last
Your answer
(CS) Home Address:
Include zip code
Your answer
(CS) Home Phone or Second Contact Number:
Your answer
(CS) Cellphone Number:
Your answer
(CS) Are you employed by the School District of Philadelphia?
(CS) If yes, please indicate your title and school assignment:
Your answer
(CS) E-mail:
Your answer
(CS) Child/Children who attend this school:
Your answer
(CS) Select the grade(s) your child or children are in:
Your answer
Members @ Large Information
If applicable, please list your Members @ Large in the following format -
Member Large - Parent - Student Large/Grade 3 - member@large.com - 215-444-4444
Member Small - Community Member - Not Applicable - member@small.com - 267-444-4444
Do you have any Members @ Large on your HSA?: *
If your HSA has Members @ Large, please list them here: (ex. Name - affiliation/grade - Email address - Phone Number):
Your answer
School Partnerships
Does your school have a: *
Required
Do you have a dedicated office space on site at your school?: *
Are there any immediate needs for your HSA from Council?
Your answer
Once all information is entered, please click SUBMIT. The Signature page will need to be printed and signed by all officers.
** ALL PERSONAL INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL AND WILL NOT BE SHARED WITH ANY OTHER ORGANIZATION**

If there are any questions, please contact Katrina Clark at phscvp1@gmail.com or 267-504-1448.
A copy of your responses will be emailed to the address you provided.
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