Neuraquest New Chapter Application Question Title * 1. Full Name of Primary Student Lead Question Title * 2. Primary student leader's email address Question Title * 3. Please provide a secondary email as a backup form of communication. Question Title * 4. Why should you lead a Neuraquest chapter? List any relevant qualifications and experiences. Question Title * 5. What is the name of your school or educational institution? Question Title * 6. Provide the link to your school's website. Question Title * 7. What state will your chapter be located in? (If outside of the US, select other and specify your location) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other (please specify) Question Title * 8. How big (number of members) do you anticipate your team/club to be? a rough estimate is sufficient. Question Title * 9. How did you hear about Neuraquest? After submitting this form, keep an eye out for an email from theneuraquest@gmail.com on the status of your chapter application and further directions. You will likely recieve a response within two weeks of submitting this form. Done