Summer Math Assessment Prep Academy

Student Name

(First Name, Last Name)

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Are you a High School student?

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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?

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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)

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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?

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