2025 PARTICIPATION RESPONSE FORM U.S. NATIONAL CHEMISTRY OLYMPIAD

Please complete this form by December 15, 2024

Local Section ID and Name *

International Chemical Sciences Chapter (if applicable)

Please check all that apply *

Yes, we will participate in the 2025 USNCO program.

I am a new USNCO Coordinator.

I am aware of changes for the 2025 USNCO program.

First name *

Last name *

E-mail *

*By providing your email, you consent to receiving emails and other communication from the American Chemical Society regarding your participation in the US Chemistry Olympiad. *

Mailing Street Address *

Address Line 2

City *

State *

Zip Code (enter 00000 if international) *

Work Phone *

Cell Phone *

Will you have a co-coordinator? *

Co-Coordinator's name *

Co-Coordinator's email: *

List other Local Section volunteers and persons involved in the USNCO program

	Name	Email
1.	Name	Email
2.	Name	Email
3.	Name	Email
4.	Name	Email
5.	Name	Email
6.	Name	Email

How do you plan to administer the USNCO Local Exam? *

Other, please explain

Do you have any suggested topics for future USNCO webinars? *

Are you or your colleagues interested in serving as a member of a USNCO task force or the governing subgroup? Read more about these opportunities and share your interest here.

By becoming a Chemistry Olympiad Coordinator, you understand and agree to:

Have read and will comply with the ACS Volunteer and Participant Code of Conduct, the ACS Youth Protection Policy, and any other applicable ACS policies and procedures, and will ensure all volunteers are compliant with the policies and procedures.
Have read and will adhere with all the UNSCO Coordinator Requirements throughout the Chemistry Olympiad program.
Disclose any perceived or real conflicts of interest to the USNCO Subgroup of the ACS Society Committee on Education, including, but not limited to the disclosure of any paid tutoring arrangements for the Chemistry Olympiad. You further understand that any real conflict of interest will result in disqualifying your involvement from coordinating, administering, or preparing the Chemistry Olympiad exams.
Treat all USNCO participants equitably.
Not alter or attempt to alter exam submissions.
Protect the security of the USNCO exams.
Not permit or participate in discussions of USNCO exams with or among students before testing windows have closed. Understand that you may discuss the exams with other USNCO volunteers.
Understand that all information will be kept in accordance with the ACS Privacy Policy.

Conflict of Interest Disclosure
Please indicate if you have any conflicts of interest related to your involvement in the Chemistry Olympiad. *

Yes

No

If yes, please disclose the nature of the conflict: *

I, the undersigned, agree to freely volunteer as a coordinator for the Chemistry Olympiad without compensation from the American Chemical Society, and agree to comply with the required obligations and standards for the Chemistry Olympiad program.

I fully and voluntarily consent to participate in the Chemistry Olympiad program, and hereby agree to accept all risks and responsibilities for losses, costs, and damages I may incur as a result of my participation in the Chemistry Olympiad program. I further hereby agree to release, indemnify, and hold harmless the American Chemical Society, its directors, officers, agents, members, employees, and volunteers from any and all claims, demands, rights, expenses, actions, and causes of action, of whatever kind, arising from or by reason of any personal injury, bodily injury, property damage, or the consequences thereof, whether foreseeable or not, resulting from or in any way connected with my participation in the Chemistry Olympiad program.

I grant the American Chemical Society full permission to use my photographs, videotapes, or any other manner of recording my participation in the Chemistry Olympiad program or activities for any purpose.

By signing and submitting this Coordinator Registration Form, I certify that I understand and have read the above carefully before signing and acknowledge that the information provided in this form is true and complete to the beast of my knowledge.

Please sign electronically *

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