Student Registration AP Connect 2016-17
First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Mailing Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Your cell phone or family phone *
Your answer
Your parent/guardian phone *
Your answer
E-mail
Your answer
Gender
What Best Describes Your Race/Ethnicity Background?
What is the highest level of education either of your parents have obtained?
Did you sign up for the College Bound Scholarship when you were in middle school? *
Academic/School Information
Year in School *
High School You Attend *
AP Connect Class *
Choose the class you would like to be a part of.
Required
Name of your AP Teacher(s) of the course(s) you selected in the previous box)
Your answer
List any other AP courses you have already taken or plan to take next year.
Your answer
Transportation
Do you need transportation to AP Connect? *
Agreement Forms
Please complete the following forms and bring them to the first AP Connect event you attend (available at http://swstemnetwork.org/uploads/3/5/4/3/3543978/apconnectenrollmentform2015.pdf):

1. AP Connect Program Activities Form
2. Emergency and Medical Information
3. Minor Photo Release Form

Forms may also be scanned and e-mailed to matthew.goosen@nconnect.org

Keep me updated about the AP Connect Program via email
Keep my parent or guardian updated about the AP Connect Program via email
Put your parent/guardians email address if the answer to this question is yes.
Your answer
Questions or Help
Contact: matthew.goosen@nconnect.org
Ph# 360-952-3609 (please leave voicemail if out-of-office)
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