Chapter Contact Appointment Form 2024-2025

Chapter Contacts: Human Rights, LGBTQ+, and Women’s Issues Contacts
Please submit the name of the Chapter Human Rights, LGBTQ+, and Women's Issues Contacts in order to receive a credit toward the registration fee to attend the 2024 LGBTQ+ Issues Conference and the 2025 Equity and Human Rights Conference. Any additional members added will be considered as a part of the chapter's Equity Team, but does not qualify for the discount.
Local (Chapter) Name*
Please specify:
Service Center Council
Office Telephone Number:*
Please list the person(s) who have been designated by the Chapter President to serve as the Chapter Human Rights Contact, LGBTQ+ Contact, and Women's Issues Contact.
Human Rights Contact*
Name of Human Rights Contact:*
First Last
Telephone Number Home:
Email Address:*
This field is hidden when viewing the form
Do you have a Co-HRAC?
Name*
First Last
Telephone Number Home
Email Address*
LGBTQ+ Contact*
Name of LGBTQ+ Contact:*
First Last
Telephone Number Home:
Email Address:*
This field is hidden when viewing the form
Do you have a Co-LGBTQ+?
Name*
First Last
Telephone Number Home
Email Address*
Women's Issues Contact*
Name of Women’s Issues Contact:*
First Last
Telephone Number Home:
Email Address:*
Do you have additional members?
Name*
First Last
Email Address:*
Name*
First Last
Email Address:*
Name*
First Last
Email Address:*
This field is hidden when viewing the form
Do you have a Co-WAC?
Name*
First Last
Telephone Number Home
Email Address:*
Consent*
The contact person(s) listed above are eligible for a credit toward the registration fee for the LGBTQ+ Issues Conference, November 15-17, 2024 and the Equity and Human Rights Conference, March 7-March 9, 2025.

The name(s) of your Chapter Human Rights, LGBTQ+, and Women’s Issues Contacts will be placed on a mailing list for future announcements of workshops and conferences.

I hereby designate the above-named person(s) to be the 2024-2025 Chapter Human Rights Contact, LGBTQ+ Contact, and Women's Issues Contact.
I agree to the privacy policy.
Signature*
Chapter President
Name*
Date*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

For Questions Contact:
CTA Human Rights Department
Post Office Box 921
Burlingame, CA 94011-0921
Phone: 650-552-5370
Email: humanrightsdept@cta.org

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Chapter Contacts: Human Rights, LGBTQ+, and Women’s Issues Contacts

Please list the person(s) who have been designated by the Chapter President to serve as the Chapter Human Rights Contact, LGBTQ+ Contact, and Women's Issues Contact.

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Chapter Contact Appointment Form 2024-2025

Chapter Contacts: Human Rights, LGBTQ+, and Women’s Issues Contacts

Please list the person(s) who have been designated by the Chapter President to serve as the Chapter Human Rights Contact, LGBTQ+ Contact, and Women's Issues Contact.

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Please Take the Immigration Enforcement at Schools Survey

Bring the Impact Home: Protecting Students and Public Education

Urge the Legislature to Pass Pregnancy Leave for Educators Act

Sign the Pledge to Support LGBTQI Students And Educators

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