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 *

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? *

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? *

Tell us more about how you found us:

Who recommended ChemClub to you?

About Your School

Are you at a Title I School? *

Yes

No

What category would your school be classified? *

What area is your school located? *

How many students are in your high and/or middle school? *

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!

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