Parents for Public Schools

Greater Jackson

Gift/Volunteer Form

2008-2009

Yes!  Count on me to help improve Jackson’s schools

through the work of Parents for Public Schools.

Yes!  Count on me to make a membership contribution to PPS of Jackson

( ) $1 - $49            Supporter

( ) $50 - $99          Advocate

( ) $100 - $499       Activist

( ) $500 - $999       Partner

( ) $1,000 or more   Reformer

Yes!  Count on me to volunteer.  I am interested in the following initiative(s):

(  )  Lunch Bunch

(  )  Parent Leadership Insitute

(  )  Ask for More  Laniers Feeder Patter

(  )  Ask for More Arts

(  )  Administrative office Help

(  )  Other

Enclosed is my membership gift of $_______.

Date   ________________

Name     _______________________________________________

Spouse   _______________________________________________

Address  _______________________________________________

City _________________  State  ______  Zip_________________

Phone:(Home) __________ (Wk) _______Spouse's Wk Ph:______

E-mail    _______________________________________________

Occupation___________________ Employer:_________________

Spouse’s Occupation:___________Employer__________________

Your Children:

Name                                  Birthdate          School or Pre-School

____________________   __________     ___________________

____________________   __________     ___________________

____________________   __________     ___________________

Demographic Information (Optional):

___American Indian   ___Asian   ___Black/African American

___Caucasian   ___Hispanic/Latino   ___Other 

Return to:                                                                                                                    

Parents for Public Schools                  

Greater Jackson

200 North Congress Street, Suite 500

Jackson, Mississippi  39201

Phone: (601) 969-6015

Fax:      (601) 969-6041

www.parents4publicschools.com/jackson