Chicago Section American Chemical Society - High School Scholarship Registration 2025

* Nominating Teacher: Name (Last/Family name, First/Given name) example: Jackson, Michael

* Nominating Teacher: Phone number 312-777-1234

* Nominating Teacher: email address example: [email protected]

* School name example: Whitney Young Magnet School

* School: Street Address example 3745 W. Addison St.

* School: City example: Chicago

* School: State Illinois or Indiana

* School: ZIP code example: 60134

* Student #1: Last/Family name example: Chavez

Student:#1: first name Example: Gwen

* Student #1: Home street address example: 1245 E. North Ave., Apartment 314

* Student #1: Home city example: Chicago

* Student #1: Home state Illinois or Indiana

* Student #1: Home ZIP code example: 60016

Student #1 email address [email protected]

* Student #1: Year in school

* Where will this student take the test?

Student #2: Last/Family Name example: Nguyen

Student #2: First name Example: Gwen

Student #2: Home Street Address example: 7743 W 57th St., Unit 3A

Student #2: Home City Flossmoor

Student #2: Home State Illinois or Indiana

Student #2: Home ZIP code example: 60068

Student #2 email address [email protected]

Student #2: Year in school

* Where will this student take the test?

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