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My Good Brain Chapter Registration Form
Thank you for your interest in becoming a My Good Brain High School Chapter! Please complete the form below and submit to let us know more about you and your chapter. We will reach out to you and follow up on your request.
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Email
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Applicant's Name (First and Last)
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Your answer
Age
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Current Grade Level
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Freshman
Sophomore
Junior
Senior
Other:
Email Address
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Phone
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Home Address
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School Name
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School Address
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City
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State
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Zip/Postal Code
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School Type
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Public high school
Private high school
Charter high school
Other:
Principal's Name (First and Last)
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Your answer
Principal's Email
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Faculty Advisor's Name (First and Last)
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Your answer
Faculty Advisor's Role (e.g., Psychology Teacher, Health Class Instructor, etc.)
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What are your main goals for starting a My Good Brain Chapter?
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Your answer
A copy of your responses will be emailed to .
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