SHS PTA STUDENT TELEPHONE DIRECTORY

* * * * * * * * * Change Request Form for 2012-2013 * * * * * *

The SHS PTA produces the Scarsdale High School Student Directory for the 2012-2013 school year. This directory is intended for informal use, to facilitate communication among students, parents, and staff. The listing for each student includes name, address, parents' first names, telephone number and grade. Although only one telephone number will be listed per residence, we do list information for second households (non-custodial parent information), if so requested (please share this information with non-custodial parents).

FOR NEW STUDENTS AND INCOMING NINTH GRADERS:  There is no need to return this form UNLESS you wish to change or add to your  information on file with the district.

FOR ALL RETURNING STUDENTS: The listing from last year's directory will be repeated unless a change is or has been already requested, or if the district provides us with more current information.

SHS PTA members will receive one directory with their paid PTA membership and can buy additional copies at $5 per copy, if ordered online by September 30, 2012 for pick up at the Parent/Teacher Conference Nights on Wednesday, October 10th for A-K and Thursday, October 18th for L-Z. Directories will subsequently, with paid membership, be available for sale at PT Conference Nights and in the main office until supplies run out. Questions? Email (no phone calls please) shspta@gmail.com

REMEMBER: To request CHANGES, ADDITIONS or DELETIONS ONLY, you must print this page, fill in the required information and SIGN and return this form (by regular mail) to:

SHSPTA, 1057 Post Road, Scarsdale, NY 10583

ONLY SIGNED, HARD COPIES OF THIS FORM WILL BE ACCEPTED

Please print the form below and send it to the above address.

Student Name: _____________________________ Current Grade__________________________

Please ADD or CHANGE the following information:

Change name of Student to:________________________________________________________

Change Address to:______________________________________________________________

Change name of Parent or Parents to:________________________________________________

Change Telephone number to (only one is listed):_______________________________________

Please DELETE (DO NOT LIST) the following (please note any deletion MUST be requested EACH year):

_______Entire Listing ______Telephone Number ______Parent name or names (Parent signature required)

_______Address ______Second Parent information (Parent Signature Required)

IMPORTANT NOTE: Initial Listing For a 2^nd Parent at a DIFFERENT ADDRESS

MUST be requested on this form

ADD or CHANGE information for second Parent at a Different Address:

2^nd Parent Name:_________________________________________________________________

2^nd Parent Address:_______________________________________________________________

2^nd Parent Phone:________________________________________________________________