Student Information Form - gilbertmath.com

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Please fill out and submit the student information sheet below.

Student Information Form

* Indicates required field

Name *

First

Last

Preferred Name (Short Form / Nickname) *

Student Number *

Please Choose Your Course *

Name of preferred parent / guardian contact *

Email address of preferred parent / guardian contact *

Home phone number of preferred parent / guardian contact *

Work phone number of preferred parent / guardian contact *

Cell number of preferred parent / guardian contact *

Is your preferred parent / guardian contact best reached by *

Do you have access to the internet at home? *

Yes No

Do you prefer to work (pick one) *

How do you feel about math? *

I love it, can't get enough of it! I like it, I guess. Meh. I don't really like it. It's the worst!

Are you "good" at math? *

I'm the best! :D I'm pretty good. :) I'm okay... :I I'm not that good. :( I'm terrible! :'(

Tell me about your goal(s) for this course *

Do you have a job? *

Yes No

If you have a job, where do you work? *

If you have a job, do you work during the week? *

If you have a job, how often do you work? *

What are your interests / hobbies? (name at least 3) *

Tell me something about yourself I wouldn't know just by looking at you. *

Submit

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