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.
Email address *
First Name
Your answer
Last Name
Your answer
City
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State/Province
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Country
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Zip/Postal Code
Your answer
Do you have prior experience with Imagination.org programs?
If yes, please explain.
Your answer
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.
Your answer
Host Organization Name
Your answer
Host Organization Type
What is your role/title at your Host Organization?
Your answer
Do the children in this prospective Chapter qualify for the U.S. Federal Lunch Program?
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)
What is the grade level of children in this prospective Chapter?
Would this Chapter be school-based?
Likely number of children to participate
Your answer
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