Application for PTO Parent Representative on a Site Base Member Team


Name______________________________________Phone (day) _________________
                                                                       
                                                                                      Phone (evening) ______________

Address_____________________________________

             _____________________________________


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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