Membership Form

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Membership Form

Thank you for your interest in joining AGATE of Port Washington! Please fill out the form below to join or to renew your membership. When you click "submit," you will receive a link to pay the $25 annual membership fee* with a credit card via PayPal. You will also be invited to donate to our scholarship fund.

*Please note that the membership fee is waived for families that qualify for free or reduced lunch. Please contact co-presidents@agatepw.org with any questions.

Name *

Today's Date *

YYYY

Address *

Best phone number to reach you:

Email address *

Please list each child you have in the school district, along with their school and grade. *

Which of the following areas of AGATE's advocacy do you consider to be very important? Check all that apply.

Ensuring that our district has a robust and fully-funded PEP program for 4th, 5th and 6th students identified as gifted and talented.

Ensuring opportunities for enrichment for all students in the Port Washington School District.

Bringing attention to the socio-emotional needs of advanced learners.

Ensuring that parents receive clear and timely information about enrichment opportunities and advanced coursework.

Advocating for the adoption of equitable methods of identifying gifted students, as recommended by the National Association for Gifted Children.

Advocating for stronger humanities courses at Weber and Schreiber.

Advocating for professional development in identifying gifted children, the writing process, differentiated instruction, and socio-emotional and developmental issues.

After you submit this form, you will receive a link to pay AGATE's annual $25 membership fee with a credit card via PayPal.

We hope you will also contribute to AGATE's Toula J. Halperin Scholarship Fund, an annual scholarship that AGATE provides to 5 Schreiber graduates who demonstrate academic achievement coupled with the passionate and dedicated pursuit of a talent, skill, or interest.

Please check the appropriate box below to indicate the amount you plan to pay via PayPal.

I will pay the $25 membership fee.

I will pay the $25 fee and make an additional donation to the Toula J. Halperin Scholarship Fund in the amount of $25.00.

I will pay the $25 fee and make an additional donation to the Toula J. Halperin Scholarship Fund in the amount of $50.00.

I will pay the $25 fee and make an additional donation to the Toula J. Halperin Scholarship Fund in the amount of $100.00.

I will pay the $25 fee and make an additional donation to the Toula J. Halperin Scholarship Fund in the amount of $250.00.

I will pay the $25 fee and make an additional donation to the Toula J. Halperin Scholarship Fund in a different amount.

My family qualifies for free or reduced lunch, so I am joining without paying the membership fee.

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