Summer Math Assessment Prep Academy
Registration Form
* Required
Student Name
*
(First Name, Last Name)
Your answer
Are you a High School student?
*
Yes
No
What school do you currently attend?
*
(Please list current High School or College)
Your answer
Are you currently taking a math class?
*
Yes
No
If yes, what math class are you currently enrolled?
Your answer
If not currently enrolled in math, please list the highest level completed
*
(please list below)
Your answer
Student E-mail Address
*
Your answer
Student's Phone Number
*
Your answer
Parent Name
(if under 18 years of age)
Your answer
Parent Phone Number
(if under 18 years of age)
Your answer
Parent E-mail Address (if known)
(if under 18 years of age)
Your answer
Winter Math Assessment Prep Academy
*
Please choose which session you would like to attend (all sessions are Monday, July 16th - Thursday, July 19th)
9:00am - 12:00pm (Lancaster Campus)
3:00pm - 6:00pm (Lancaster Campus)
9:00am - 12:00pm (Palmdale Center)
Who should we contact in case of emergency?
*
Your answer
Emergency Contact Phone Number
*
Your answer
Reasonable accommodation will be provided to facilitate the particpation of covered individuals with disabilities.
*
Will you need these services?
Yes
No
Submit
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