CHSI Application | Celebrating High School Innovators

Application

Team Leader Name *

Team Leader Last Name *

Team Leader Street Address *

Team Leader City *

Team Leader State/Province *

Team Leader ZIP / Postal Code *

Team Leader Email Address *

Team Leader Phone Number *

School Name *If homeschooled, put homeschool0 / 180

Principal Name *If homeschooled, put homeschool

Team Leader Year in School *

Team Leader Parent/Guardian Name *0 / 180

Team Leader Parental Email Address *

Team Advisor *0 / 180

Team Advisor Email *0 / 180

Influential Person *What person has made the biggest impact on you?0 / 180

If you have no other team members, simply skip this step.

Team Member 1 Information

Team Member 1 Name0 / 180

Team Member 1 Email Address

Team Member 1 Parental Email Address

Team Member 1 Phone

Team Member 1 Street Address

Team Member 1 Apartment, suite, etc

Team Member 1 City

Team Member 1 State/Province

Team Member 1 ZIP / Postal Code

Team Member 1 Country

Team Member 1 Year in School

Team Member 2 Information

Team Member 2 Name0 / 180

Team Member 2 Email Address

Team Member 2 Parental Email Address

Team Member 2 Phone

Team Member 2 Street Address

Team Member 2 Apartment, suite, etc

Team Member 2 City

Team Member 2 State/Province

Team Member 2 ZIP / Postal Code

Team Member 2 Country

Team Member 2 Year in School

Team Member 3 Information

Team Member 3 Name0 / 180

Team Member 3 Email Address

Team Member 3 Parental Email Address

Team Member 3 Phone

Team Member 3 Street Address

Team Member 3 Apartment, suite, etc

Team Member 3 City

Team Member 3 State/Province

Team Member 3 ZIP / Postal Code

Team Member 3 Country

Team Member 3 Year in School

Team Member 4 Information

Team Member 4 Name0 / 180

Team Member 4 Email Address

Team Member 4 Parental Email Address

Team Member 4 Phone

Team Member 4 Street Address

Team Member 4 Apartment, suite, etc

Team Member 4 City

Team Member 4 State/Province

Team Member 4 ZIP / Postal Code

Team Member 4 Country

Team Member 4 Year in School

Team Member 5 Information

Team Member 5 Name0 / 180

Team Member 5 Email Address

Team Member 5 Parental Email Address

Team Member 5 Phone

Team Member 5 Street Address

Team Member 5 Apartment, suite, etc

Team Member 5 City

Team Member 5 State/Province

Team Member 5 ZIP / Postal Code

Team Member 5 Country

Team Member 5 Year in School

Team Member 6 Information

Team Member 6 Name0 / 180

Team Member 6 Parental Email Address

Team Member 6 Email Address

Team Member 6 Phone

Team Member 6 Street Address

Team Member 6 Apartment, suite, etc

Team Member 6 City

Team Member 6 State/Province

Team Member 6 ZIP / Postal Code

Team Member 6 Country

Team Member 6 Year in School

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