Incomplete Registration Form
Please complete this survey if a month has passed since you registered and you haven’t received your incentive payments. Once submitted, our team can update your registration and can begin processing your incentive payments.
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Email *
Parent/Guardian Email Address Used for Testing Registration *
Please enter the email address you used to register your student/minor, this is also the email address where you receive results.
Phone Number Entered at the time of Testing Registration *
Secondary Phone Number
Please enter this if you have a number you use instead of the one entered at the time of registration.
Parent/Guardian Date of Birth *
Please enter the legal parent or guardian's date of birth over 18 years of age.
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Physical Mailing/Home Address *
Student/Minor First and Last Name *
Student/Minor School Name *
Student/Minor Date of Birth *
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Multiple Student/Minors Participating in Safer, Smarter Schools? *
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