School Membership Application Form

Application for Chess Class at Public Schools

To apply for membership please complete all questions.
School Name
Region
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Principal Name

First NameLast Name
Principal E-mail
Principal Telephone

Area CodePhone Number
School Information

Please use data for the current year.
Total Enrollment of Students
Percent (%) of Students Eligible for Free Lunch
Percent (%) of Special Education Students
Percent (%) of Bilingual Students
Number of classes per grade
Kindergaten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
Please enter the contact information of the staff member from your school that will be responsible for ongoing communication with Chess and Kids as the Chess Coordinator below.
Name

First NameLast Name
Job Title
Phone Number

Area CodePhone Number
E-mail
Please enter your contact information in case we need to contact you regarding this submission.
Your Name
Your Telephone
Your E-mail
Should be Empty:

Application for Chess Class at Public Schools