Nsoromma's "Math & Media Mashup" Summer Program 2017 - APPLICATION
Please complete this application/registration form. When you click SUBMIT, you will be taken to a payment page. Both completed application and payment are needed to complete your child's registration.
Email address *
Student Name *
Your answer
Grade *
School *
Your answer
Gender *
Parent(s) Name(s) *
Your answer
Address (include city and zipcode) *
Your answer
Re-enter Parent email (that is checked regularly) *
Your answer
Parent phone number *
Your answer
FOR STUDENTS: Why are you interested in this program? *
Your answer
Most recent math grades *
Has your child ever had learning or behavioral challenges or issues that required tutoring, counseling, special classes, etc.? *
Your answer
What other information about your child do you feel we need to know? (allergies, physical limitations, medical, etc..) If any, please describe. NOTE: This information is very important in helping us to determine how we can best meet your child’s needs in this program.
Your answer
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