Rosters

Please complete and submit this form immediately following your elections, even if some of your officers are serving a second term. The California State PTA will use this information to send you important summer mailers. 17th District PTA will use this information to update our District Directory, to be printed in August. None of this information will be shared or used outside of 17th District, California State, and National PTA.

This online form will automatically submit your roster data to 17th District and to your council (if applicable).
If you do not want to submit online, a PDF form and a Microsoft Word form are available for download. If you’re in-council, you should send these directly to your council, who will forward them on to 17th District.

The deadline for this form to 17th District is April 30. Councils may have an earlier deadline. Even if you missed this deadline, please submit this form to us as soon as you can.

Association Data

If your web browser supports it, you can hover over prompts that are underlined with your mouse to see additional information about how to find/provide the requested information. Please note that you should have a copy of your bylaws handy to fill out this first section.

Name of Association:
Street Address:
City:    Zip: 
California PTA unit #:
National PTA unit #:
Grades in School:
Organization Date:
Name of Council:
Bylaws Form Revision Date:
Election meeting held:
Officers assume duties on:
Fiscal year ends on:

Required Officers per Article V Section 2

Every PTA/PTSA must have a President, Secretary & Treasurer.
Please indicate "Vacant" if position is to be filled at later date OR "N/A" if the position is not applicable (i.e. not listed as a position in your bylaws). If the position has ben filled, choose "Information Specified Below" and provide the information requested. Please provide home addresses to expedite receipt of date sensitive materials.

President  Vacant   Information Specified Below
Name:
Street Address:
City:    Zip: 
Home Phone:   Work Phone: 
Fax:   Cell Phone/Pager: 
E-mail Address:

Executive Vice President  N/A   Vacant   Information Specified Below
Name:
Street Address:
City:    Zip: 
Home Phone:   Work Phone: 
Fax:   Cell Phone/Pager: 
E-mail Address:

Treasurer  Vacant   Information Specified Below
Name:
Street Address:
City:    Zip: 
Home Phone:   Work Phone: 
Fax:   Cell Phone/Pager: 
E-mail Address:

Secretary  Vacant   Information Specified Below
Name:
Street Address:
City:    Zip: 
Home Phone:   Work Phone: 
Fax:   Cell Phone/Pager: 
E-mail Address:

Auditor  N/A   Vacant   Information Specified Below
Name:
Street Address:
City:    Zip: 
Home Phone:   Work Phone: 
Fax:   Cell Phone/Pager: 
E-mail Address:

Historian  N/A   Vacant   Information Specified Below
Name:
Street Address:
City:    Zip: 
Home Phone:   Work Phone: 
Fax:   Cell Phone/Pager: 
E-mail Address:

Parliamentarian  N/A   Vacant   Information Specified Below
Name:
Street Address:
City:    Zip: 
Home Phone:   Work Phone: 
Fax:   Cell Phone/Pager: 
E-mail Address:

Other Contacts

Principal  N/A   Vacant   Information Specified Below
Name:
Street Address:
City:    Zip: 
Home Phone:   Work Phone: 
Fax:   Cell Phone/Pager: 
E-mail Address:

Reflections Chair  N/A   Vacant   Information Specified Below
Name:
Street Address:
City:    Zip: 
Home Phone:   Work Phone: 
Fax:   Cell Phone/Pager: 
E-mail Address:

Anti-Spam Verification

Please review all the information provided here before you submit to be sure it is correct. Clicking the Submit button will send all the information provided to the 17th District PTA and your council (if applicable); you will be given a chance on the next page to print this data for your records.