Wisconsin HOSA NEW Chapter Request Form for Middle and High Schools

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Thanks for your interest in HOSA-FHP! Please note, the following criteria to complete this form and request new chapter start-up.

I will be serving as the...
1.) Middle School and/or High School Chapter Advisor, AND
2.) have received administration approval to start a HOSA chapter at my school.

INSTRUCTIONS: 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 communications from HOSA-FHP and Wisconsin HOSA once your chapter has been established. Be sure to check your spam/junk inbox as sometimes HOSA emails will be filtered there first by your school district.

Email *

New Chapter Advisor Name (First and Last) *

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

Co-advisor Email Address, if applicable

School Name *

My school administration has approved the start-up of a local HOSA Chapter. *

Yes

I am in the process of obtaining approval.

Select the chapter division level. *

Secondary School (SS) - High School

Middle School (MS)

Both divisions (MS & SS Chapter)

Required

Name of HOSA Chapter (if different than school name)

Work Phone Number *

School Mailing Address (Street, City, Zip Code to received mailed items) *

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

I acknowledge by completing this form, I have read and agree to follow the Chapter Advisor Responsibilities and Code of Conduct located at: https://docs.google.com/document/d/1vadcosiSIxFNsfPtKdTRud1bAMvIihRIZiabgPaYXNY/edit?usp=sharing *

Yes, I agree

Send me a copy of my responses.

Submit

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