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Does your school wish to continue as a chartered member of the ACS ChemClub Program for the 2016-2017 school year? *
Will you continue as advisor for the ChemClub at your school? *
Do you have any co-advisors? *
If more than 1 coadvisor, please list the others in the the comment section at the end.
Do you have a club email address? (An email that students/officers in the club can access) *
Why do you wish to discontinue your ChemClub association? *
 
Will you start a ChemClub at your new school? *
Is there another teacher that would be willing to take over the ChemClub? *
Please provide contact information for the new advisor for the next academic year.
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