Club Application Student Founder

Student Founder Profile

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Year in School *

GPA *

Clubs *

Leadership Roles *

Community Service *

Student Founder Commitment Profile

Please answer the following to best describe your commitment to founding an Education Rocks club at your school.

How did you learn about Education Rocks, and what experiences makes you an exceptional candidate to be an Education Rocks Student Founder? *

School Profile

School Name *

School Type *

School Address *

Address Line 1

Address Line 2

City

State

Zip Code

School Size *

School Grade Levels *

Phone *

Fax

Website / URL *

Please list other community service clubs or organizations at your school

Applicant's Name *

Date *

Applicant's Signature *

Parent Name *

Parent Signature *

Name