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ACS High School ChemClub Application
***This application should be submitted by faculty sponsors only***
Has your school had an ACS ChemClub affiliation previously?
*
Yes
No
School Name
*
School Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Outside the United States
Zip Code
*
School Phone Number
Extension
School Website
*
Country
*
Advisor Information
Were you the previous advisor?
*
Yes
No
First Name
*
Last Name
*
Email Address
*
Do you have a co-advisor?
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Yes
No
Co-Advisor First Name
*
Co-Advisor Last Name
*
Co-Advisor Email Address
*
Club Email Address (different from an advisor's email)
🛈
How did you learn about the ACS ChemClub?
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ACS website
ACS Meeting
Email
AACT website
NSTA Conference
ChemMatters
Social Media
Project SEED
Recommendation
Other
Tell us more about how you found us:
🛈
Who recommended ChemClub to you?
About Your School
Are you at a Title I School?
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Yes
No
What category would your school be classified?
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Public
Private
Home School
Parochial
Other
Other
What area is your school located?
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Metropolitan
Large City
Small City
Rural
Other
Other
How many students are in your high and/or middle school?
*
100 or fewer
101-400
401-1000
1001-2000
2001+
Do you have any initial questions?
The students at the above high school, under the leadership of the faculty advisor listed above, apply for recognition as an official ACS-Sponsored High School ChemClub.
Endorsed by: (faculty advisor)
*
Once your application is processed, you will receive a welcome email within 2 weeks. Welcome to ChemClub!
Notice
: By participating in the ChemClub program you are consenting to receive email communication from ACS/AACT related to the program throughout the 2020-2021 school year. Your email address will not be shared externally.