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
Last Name
Zip/Postal Code
Do you have prior experience with programs?
Clear selection
If yes, please explain.
Do you have formal experience as an educator?
Clear selection
Please tell us why you want to be an Imagination Chapter Leader and share any relevant experience.
Host Organization Name
Host Organization Type
What is your role/title at your Host Organization?
Do the children in this prospective Chapter qualify for the U.S. Federal Lunch Program?
Clear selection
Do the children in this prospective Chapter qualify as "High Need" by another definition?
Clear selection
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
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