STUDENT INTEREST FORM TEACHER INTEREST FORM

Student Interest Form

To enroll in the Oakland/East Bay Math Circle Monday classes students should fill out the information requested below.

Note: The individual details collected will only be used to contact students and parents or guardians with information related the Oakland/East Bay Math Circle. Student information will not be released to any other party.

I. Personal

Children under 15 require permission from a parent or guardian to fill out this form. Check this box if you have their permission.
First and last name:
Email address:
Name of School:
Current math teacher (or math activities advisor):
Grade:
Name of parent of guardian:
Parent or guardian's e-mail address(es):
Parent or guardian's evening/weekend/home phone number (include area code):
Postal street address:
P.O. Box (if you have one):
City:
Zip code:
Emergency Contact for day of program:
Phone Number of Emergency Contact During the time of the Math Circle program (include area code):

II. How did you hear about us?

How did you hear about this program? (If from a friend, teacher, or counselor, please write the person's name here.)
 
Finished with the application?
Press submit: