Make extra copies of blank form as needed

							                                   GEORGIA PTA REFLECTIONS AWARD RECIPIENTS LOG (FORM B)
                                  (Use this form to transmit entries from Local Units to Council AND from Councils to State)
Make extra copies of blank form as needed.                                                      NOTE: Only 2 entries per grade level for each of the
Photocopy completed form for your files.                                                        six arts categories (from Councils to State).
Print legibly in black ink or type.

School/PTA Local Unit                                                                           PTA Council           Choose one    District
Address                                                                 City                                    Zip           Phone (      )

National PTA 8 Digit ID Number:      00
Reflections Chair                                                                               Email Address
Address                                                                 City                                 Zip                  Phone   (     )

    GRD CAT         STUDENT'S SCHOOL              STUDENT'S NAME                           ADDRESS                             CITY       ZIP           PHONE
 1 PreK    LI                                                                                                                                       (   )

 2 PreK    LI                                                                                                                                       (   )

 3 PreK    LI                                                                                                                                       (   )

 4 PreK    LI                                                                                                                                       (   )

 5 PreK    LI                                                                                                                                       (   )

 6 PreK    LI                                                                                                                                       (   )

 7 PreK    LI                                                                                                                                       (   )

 8 PreK    LI                                                                                                                                       (   )

 9 PreK    LI                                                                                                                                       (   )

10 PreK    LI                                                                                                                                       (   )

11 PreK    LI                                                                                                                                       (   )

12 PreK    LI                                                                                                                                       (   )

13 PreK    LI                                                                                                                                       (   )

14 PreK    LI                                                                                                                                       (   )

15 PreK    LI                                                                                                                                       (   )

16 PreK    LI                                                                                                                                       (   )

GRD = Grade Level    CAT = Category = Literature (LI), Visual Arts (VA), Music (MU), Photography (PH), Dance Choreography (DC), Film/Video (FV)             25