Chess in Schools Hand-off - Cris Collinsworth ProScan Fund

Introduction:

The Cris Collinsworth ProScan Fund's (CCPF) Chess in Schools Program is pleased to offer a "hand-off" option, in which CCPF provides chess materials for a school staff person to teach and lead chess. To participate in this capacity, please complete the form below.

School Information

School Name*

School Address*

Street Address Address Line 2 City State ZIP Code

School Contact

Name*

First Last

Title*

Email*

Work Phone*

Mobile Phone

School Staff Person to Teach Chess

Name*

First Last

Email*

Title*

Work Phone*

Mobile Phone

Please briefly describe staff person's experience with chess.*

Will school staff person need training by CCPF?*

Yes
No

What day/time will chess be held?*

Anticipated Start Date for Chess*

Anticipated # of Participants*

I understand that the Cris Collinsworth ProScan Fund will provide the following:*

Boards/pieces for school use (All boards and pieces are property of CCPF); Curriculum for use by staff person(s) leading chess; Demonstration board for staff person(s) leading chess. Optional training for staff person(s) leading chess.

Yes

I understand that the Cris Collinsworth ProScan Fund is not responsible for:*

Any/all injuries during class time; Any/all disciplinary actions; Student transportation before and after class; Student attendance

Yes

Comment(s)

Disclaimer and Signature*

By submitting this form, I certify that my answers are true and complete to the best of my knowledge.

Yes

Please sign by typing your full name:*

Today's Date*