Imagination Chapter Application
Please take a moment to fill out this form to help us learn a little bit about you and the community you plan to serve as an Imagination Chapter.
Do you have prior experience with Imagination.org programs?
If yes, please explain.
Do you have formal experience as an educator?
Please tell us why you want to be an Imagination Chapter Leader and share any relevant experience.
Host Organization Name
Host Organization Type
Youth Development Organization
Other Community Organization
Place of worship
What is your role/title at your Host Organization?
Do the children in this prospective Chapter qualify for the U.S. Federal Lunch Program?
At least 50%
At least 75%
Not to my knowledge
Do the children in this prospective Chapter qualify as "High Need" by another definition?
Please explain your definition of "High Need" (select all that apply)
Unstable home environment
What is the grade level of children in this prospective Chapter?
Would this Chapter be school-based?
Not in school
Likely number of children to participate
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