NEW Chapter Request Form for Postsecondary/Collegiate Institutions

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Thank you for your interest in starting a Wisconsin HOSA chapter! Please note, the following criteria is must be met to complete this form and request the registration of a new chapter:

1) The chapter will be at a tech school, college, or university located in the state of Wisconsin.
2) I plan to serve as the advisor for the HOSA chapter.
3) I have received administration approval to start a HOSA chapter at my school as a student organization.

Please provide the following information to initiate the process to charter your school with the state and international organizations. You will receive a follow-up communication from the State Advisor once your chapter has been established.

Email *

School Name *

Name of HOSA Chapter (if different than school name)

Advisor Name *

Advisor's Phone Number *

Co-advisor Name (First and Last), if applicable

Co-advisor Email Address, if applicable

Address for Receiving Mailed Items (Street, City, Zip Code) *

Select the chapter division level. *

Postsecondary (PS) - Community/Technical Colleges

Collegiate (CO) - 4 year Colleges/Universities

Required

List your preferred day/s of the week and time/s to schedule your new chapter advisor orientation meeting (approximately 30 minutes - required for new chapters). You will receive an email to confirm the specific date and time to be scheduled. *

Indicate how you heard about HOSA (Select all that apply) *

HOSA Mailing

Community Member/Partner Advocated

Current HOSA Advisor Advocated (please indicate name of advisor below by selecting the "Other" option)

DPI/Health Science Communication

Former HOSA Advisor (served as a HOSA Advisor at another school/district)

Parent/Family Member Advocated

School Administration/District CTEC

Social Media

Student Interest

Wisconsin HOSA Ambassador Contacted

Wisconsin HOSA Website (www.wihosa.org)

Other:

Required

Send me a copy of my responses.

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