The AXA Foundation, the philanthropic arm of AXA US, is the proud sponsor of PTA's Take Your Family to School

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1 2015 Take Your Family to School Week: Event Sign Up Form and Grant Application OVERVIEW National PTA s Take Your Family to School Week February 16-20, 2015 will focus on the theme Supporting Student Success to promote family engagement solutions that are proven to help prevent the risks associated with high school dropout. The AXA Foundation, the philanthropic arm of AXA US, is the proud sponsor of PTA's Take Your Family to School The AXA Foundation has been a proud National PTA sponsor since National PTA will ship PTA Take Your Family to School Week Kits to a total of 200 PTAs including:: The first 150 PTAs that sign up to host an event and 50 PTAs that receive a $1,000 grant for hosting at least two events What are the requirements for the kit and grant recipients? Grant applicants and kit recipients must be PTAs in good standing with their state PTA, and be a 501(c)(3). 150 PTAs that receive the kit must host one PTA Take Your Family to School Week event and agree to complete a post-event survey 50 PTAs that receive a kit and a $1,000 grant must host two PTA Take Your Family to School Week events and agree to complete a post-event survey Key Milestones and Dates Activity Grant Info Webinar: Introduction to the Take Your Family to School Week program and grant opportunity. Grant applicants receive 5 bonus points for attending one webinar. Key Date Monday, September 29 from 3 to 4 p.m. ET/12 to 1 p.m. PT. Thursday, October 9 from 7 to 8 p.m. ET/4 to 5 p.m. PT. Grant Application Deadline Monday, November 3 5 p.m. ET/2 p.m. PT Grant recipients notified Monday, December 1 Take Your Family to School Week Kit ships to 50 grant recipients and first 150 PTAs to complete event sign up form Monday, December 1 Take Your Family to School Week February 16-20, 2015 Post-event Survey Due March 31, 2015 Questions? Contact us! Please send any questions to programs@pta.org or call

2 EVENT-SIGN UP FORM Complete form below to sign up for PTA s Take Your Family to School Week. The first 150 PTAs that sign up for Take Your Family to School Week will receive a FREE toolkit to support their events! Start planning today visit to explore tools for getting started. Check all that apply: Yes! I am the President or a Board member of a PTA in good standing with my State PTA and I have the authority to sign up my PTA for Take Your Family to School Week. Yes! Put our Take Your Family to School Week events on National PTA s interactive map for nationwide promotion. Yes! I will complete a survey in March to tell National PTA more about our Take Your Family to School Week events. Grant and kit recipients are obligated to complete a post-event survey to share information about attendees PTA Information Official PTA/PTSA Name: PTA Unit ID Number (To find your PTA s ID number, contact your state PTA or call (800) ): Primary PTA Contact Information First Name: Last Name: PTA Role (president, board, member, etc.): Address 1: Address 2: City: State: Zip: Phone:

3 School Information School Name: School Principal First Name: School Principal Last Name: Address 1: Address 2: City: State: Zip: Phone: Number of students enrolled: Check all that apply: Elementary School Intermediate (Middle) School Secondary School K-8 Public Private Charter Title 1 School If you are among the first 150 PTAs to sign up your event or receive a grant, ship kit to. Primary Contact Address School Address

4 School Demographics To find demographic information for your school, ask you principal, visit your school or school district web site, or use the info found on Greatschools.org. Provide percentages below: % Students qualifying to receive free/reduced price lunch % Hispanic/Latino % Black/African American % American Indian/Alaska Native % Asian/Pacific Islander % White/Caucasian % Other Event Info Using the tools at indicate what your event will focus on from the following topics (check all that apply): Supporting Student Success English Language Arts, Math or Science Bullying Prevention Arts (Reflections) Creative Career Fair Multicultural Event We plan to engage student leaders in planning, promotion and delivery of event: Yes No Undecided Event date(s) (Must have at least two events if applying for grant): Date: Date: Date: Include a 1-2 sentence description about your event(s) for display on the interactive map. (Maximum 100 words) Yes! A PTA representative will complete a post-event survey providing information about attendees, media hits, activities, and feedback for future program tools. Yes! We want to answer a few more questions to apply for a $1,000 Take Your Family to School Week grant. No! We do not want to apply for a grant. Please submit my event information.

5 GRANT APPLICATION Complete form below to be considered for a $1,000 grant to support PTA s Take Your Family to School Week. Agreement to Grant Requirements (45 points) On behalf of PTA, we agree to: Plan and implement at least two family education activities during Take Your Family to School Week (February 16-20, 2015). (15 points) Attend one of the training webinars hosted in December or January (15 points) Complete a brief online grant evaluation form before March 31, (15 points) Information collected includes: Attendee breakdown (i.e., # parents, # teachers, # students, government or elected officials, local or national celebrities, other community members) Information about the event Program promotion Media hits Photos and/or video Feedback on the program tools and support provided by National PTA Narrative (50 points) 1. In a maximum of 250 words, describe your PTA s most successful family education event in the past three years. (25 points)

6 2. In a maximum of 250 words, describe the needs of your school community. Consider the student needs, the family needs, and the surrounding community needs. How will Take Your Family to School Week help to address those needs? (25 points) Anticipated Budget Needs (5 points) 3. Based on your PTA s past experience with family education events or your plans for Take Your Family to School Week, how do you anticipate spending the $1,000 grant to implement at least two events during Take Your Family to School Week? (100 word maximum - 5 points)

7 Bonus Points (5 points) Yes! A representative from my PTA attended one of the Grant Information Webinars on this date:. Attendee Name: Attendee Address: Contact Information Please send any questions about grant eligibility and/or the application process to programs@pta.org or call