Student Interest Form

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.

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

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:

How many times do you check your email per week?

Birthyear:

Grade:

Name of School:

Current math teacher (or math activities advisor):

Name of parent of guardian:

Parent or guardian's e-mail address(es):

Parent or guardian's daytime/work phone number (include area code):

extension, if applicable:

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:

Can we give your contact information to other people in your area (to arrange car-pooling)? (Yes or no):

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: