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Science Action Club Enrollment Application
Please complete this form to apply for Science Action Club (SAC).

Before you continue, please review the SAC Enrollment Application Preview document here:

Email address *
Agency Contact Person *
Primary point of contact for CalSAC
Your answer
Title *
Your answer
Phone Number *
Your answer
Alternate Phone Number *
Your answer
Name of Agency *
Your answer
Street Address *
Please do not use abbreviations.
Your answer
City *
Your answer
State *
Your answer
Website *
Your answer
Agency Type *
Does your agency receive ASES or 21st CCLC funding? *
What is your agency's annual operating budget? *
Your answer
Would you like to request a fee waiver? *
Please describe your need for a fee waiver.
Your answer
Are you also interested in enrolling programs for summer? *
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