BEA Learning Interest Registration Form (K-12 Students)
IMPORTANT:
All BEA education programs are for free. The education programs are primarily operated by high school student volunteers but supervised by directors/educators for quality.

By filling in this form, you give us your consents to use your and your children's information for the purpose of running BrookEdge Academy's learning programs. BrookEdge Academy ("BEA") will not share the information with anyone outside of BEA intentionally. Please ensure this form is filled by an adult, if the students are under the age of 18.

This registry is intended to collect interest of learning and does not guarantee an actual offer of a typical "class." When sufficient interests in the same area from students round the similar levels for proper grouping justify a group class, the students will be then notified in due course. Or otherwise arrangements are made to cater for your child's learning interests.

Please fill in all the required (*) fields. One student one form. Thank you.

In case of amendment assistance or technical difficulties, please contact BEA by emailing to brookedgeacademy@gmail.com
1.First Name (Student) *
2.Last Name (Student) *
3.Preferred first name (if different from above)
4.Current Grade (Student) *
5.Immediate Learning Interest Subjects (please assess and choose only one of the following options) *
Required
6.Specific Areas of Immediate Learning Interest (required to specify if you chose English for Question 5 above; check the areas to suit your child's learning needs - no limit here)
7. Specific Areas of Immediate Learning Interest (required to answer if you chose Math for Question 5; check the areas to suit your child's learning needs - no limit here)
8.Math Contest of Interest (required to answer if you choose competitive math for Question 7; please assess and put down only one name of the contests)
9.Self-assement of Student's Overall Current Level of the Immediate Learning Interest Subject on a scale from 1 to 10. *
Very Behind Curriculum Requirements
Very Beyond Curriculum Requirements
10.Which Curriculum Is the Student Self-assessment Evaluating against? (Format: City, State/Province, Country) *
11. Non-immediate Learning Interests
Clear selection
12. Generally speaking, my child is interested in *
Required
12. Parent's Email Address *
13. Preferred Email Address for Communication with BEA (if different from the answer to Q12 above)
14. Parent's phone number (For Emergency Contact) *
15. Parent's Sign-Off – please type your legal name. [IMPORTANT: by printing your legal name here, you: (1) acknowledge that this form is correctly filled in; and (2) authorize BrookEdge Academy to collect and use your children's information for support of their learning needs; and(3) permit BrookEdge Academy and your children to use technology to run the education programs where necessary and appropriate; and (4) agree to receive notifications from BrookEdge Academy about similar programs of your child's learning interests. Do not submit this form if you do not wish to do so. After submission, if you want to withdraw your consents and authorization at any future point, please email brookedgeacademy@gmail.com] *
16. Form Submission Date *
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