Summer Math Assessment Prep Academy
Registration Form
* Required
Student Name
*
(First Name, Last Name)
This is a required question
Are you a High School student?
*
Yes
No
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What school do you currently attend?
*
(Please list current High School or College)
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Are you currently taking a math class?
*
Yes
No
This is a required question
If yes, what math class are you currently enrolled?
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If not currently enrolled in math, please list the highest level completed
*
(please list below)
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Student E-mail Address
*
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Student's Phone Number
*
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Parent Name
(if under 18 years of age)
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Parent Phone Number
(if under 18 years of age)
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Parent E-mail Address (if known)
(if under 18 years of age)
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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)
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Who should we contact in case of emergency?
*
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Emergency Contact Phone Number
*
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Reasonable accommodation will be provided to facilitate the particpation of covered individuals with disabilities.
*
Will you need these services?
Yes
No
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