Period101 Chapter Application Form
Submit this form to apply to start a Period101 Chapter at your school. If you have any questions or concerns, do not hesitate to send an email to period101organization@gmail.com! 

Once you fill out this form we will contact you to set up a Zoom meeting.
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Personal Email Address *
Name of School 
*Please write the full name of the school/organization you would like to start a chapter at (e.g., Thomas A. Edison High School.) We will create a Period101 logo with your school name on it! 
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School District
*If you attend private school, please write the county or city your school is located in. 
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School Type  *
Club Sponsor(s) Name  *
Club Sponsor(s) Email(s) *
Student Leader 1 Name 
*Please provide first and last name.
 *
Student Leader  1 Email
*Please provide non-school adress. 
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Student Leader 2 Name 
*Please provide first and last name.
 *
Student Leader 2 Email 
*Please provide non-school address.
 *
Name/Email of any additional officers
By selecting the "I agree" button, I confirm that I understand Period101's expectations for all club sponsors and student leaders to uphold the Period101 mission of fighting period poverty, and am committed to doing so. *
By selecting the "I agree" button, I confirm that I understand the expectations for my Period101 Chapter. If I have concerns about meeting these expectations, I will contact Period101 staff to discuss the issue and support needed.  *
By selecting the "I agree" button, I confirm that I understand that Period101 is a pre-existing organization and that I am starting a chapter of Period101 to spread awareness about period poverty.
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