2023-2024 OVX-VKAT Chapter Registration
Please use this form to provide the VDH Tobacco Control Program with the most up-to-date information about your Chapter and to register for activities, resources, and advisor support for the coming school year. If you have any questions about completing this form, please contact TCP Project Facilitator Alex Lehning at alex.lehning@vermontstate.edu.
Advisor Name
*
First Name (Pronouns)
Last Name
Title
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
School or Organization
*
Grade Levels
*
Our Voices Xposed (9-12)
VT Kids Against Tobacco (5-8)
Other
Name/Email of Additional Advisors (or n/a)
Is your Chapter new?
*
Yes, this is our first year
No, we participated last year
Other
Number of Members
Approximate the number of students/youth participating in 2023-2024.
Is your Chapter integrated with another organization?
*
GSA
SADD
Getting to Y
Other
How if your Chapter funded?
VDH DSU Vaping Grant
VDH TCP Grant
AOE
SU or School Funding
Other
Do you have any questions, requests for support, or comments?
Submit
Should be Empty: