Keller & White Winter 2022
Class Registration Form
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Student Name *
Student Email -- not your school email please! *
Preferred Section *
Parent/Guardian Name *
Parent/Guardian Email   *
Address *
Parent/Guardian Phone number *
What high school do you attend? *
What year will you be entering in the coming fall?
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What math class are you entering this year? *
What were your most recent SAT or PSAT scores?  Please tell us the math and verbal scores from your most recent test.  If you  know your verbal sub-scores (reading and writing) please tell us those too. *
Did you have any older siblings who have worked with Keller & White? And if so, where are they now?
How did you hear about Keller & White?
And finally, how would you like to submit your tuition payment? *
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