School Year:______________

WINSTON CHURCHILL HIGH SCHOOL NEW CLUB REQUEST

Please complete all information below. Print legibly.
Request Date_______________________
Proposed Club Name______________________________________________________________
Time/Date of month, Room # for Club Meetings_________________________________________
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Mission of Club (what club hopes to accomplish)
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Note: Full Club and Academic Team description should be included on back. (This will go on the
school website to help promote your club and academic team)
Name of proposed Officers, grade level, and student ID#
1.____________________________________2. ________________________________________
3.____________________________________4. ________________________________________
Type of proposed Fund Raising Activities______________________________________________
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Sponsors Name(print)______________________Sponsors Signature________________________
Members Name(print)______________________Members Signature_______________________
Who to notify about Club status: (please include name +phone number+email)
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Approved________________________________Not Approved____________________________
Comments_______________________________________________________________________
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School Year:______________

Club Description
Please describe what your club intends to accomplish. Include how often you will meet, the day(s) it
will meet (if known), what you intend to accomplish at these meetings, any fundraising you are
planning, will there be events outside of school time, and what is expected of members.
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Submitted by(print name+title)_______________________________________________________

Members Signature_____________________________________Date________________________
Sponsors Signature_____________________________________Date________________________