DSSGx new chapter application form
Email address *
Name of the proposed DSSGx Chapter: *
(e.g. “DSSGxBerlin”; the name you choose should ideally reflect the unique location, such as a city, neighborhood of the community you belong to and/or want to support. If your team is primarily working from or affiliated to a university your chapter can be named after the university.)
Details regarding your organisation (if applicable) : *
(e.g. University of XYZ, or Amazon; in case there is nothing to add here, just write none)
Full Name of Chapter Lead: *
(note, chapter lead is responsible for ensuring DSSGx guidelines on events and projects are followed):
Names of other Chapter members: *
(people who are interested in creating a chapter and have agreed to jointly make the application for the DSSGx chapter)
Phone number
Please insert your country code with prefix 00 (not +)
Website (if applicable):
Twitter hashtag (If applicable):
Please describe the kinds of activities you foresee that your DSSGx Chapter will focus on in the coming 12-24 months: *
(examples can include events you want to organize, projects you want to work on, project partners you would like to partner with, etc.)
What is your funding situation? Are you planning to fundraise? *
DSSG X Guidelines
I, Chapter lead, hereby agree to ensure DSSGx guidelines will be enforced in my DSSGx Chapter. *
Required
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