Student information form

First Name *

Last Name *

Do you have access to a computer with a working internet connection? *

At home

Personal laptop

Library

Another family member or friend that allows you to regularly use it

Cell Phone

None of the above

Other:

Required

What is your new or current gmail address? *

(Should look like name@gmail.com)

Did you add me as a coach on Khan Academy? *

Yes

No

What are some of your hobbies or things you like to do outside of school? *

What do you plan to major in at college? *

Is math ... *

Very Difficult

1

2

3

4

5

6

7

8

9

10

Extremely Easy