Teacher Interest Form

Thanks for your interest in ChemQuiz.net! Please complete the following form so I can contact you about setting up an account.

A school-wide site license is available for $50 per school year (July 1 - June 30), which allows you to add an unlimited number of students.

If you have a coupon code, please include that below. If your school or district has 50% or greater economic disadvantage (e.g., students on free/reduced lunch) and you want to apply for a free site license, please include a link to your school or district demographics in the 'Coupon Code' field.

* Required form fields

Your Name *
Your Email Address *
School Name *
School District *
School Address *
School City *
School State/Province *
School Zip/Postal Code *
School Country *
School Phone Number
School Website
Coupon Code/Demographic Link
(if applicable)
Sign up for email updates about ChemQuiz
(optional)
Additional Info/Questions/Comments