AP Chemistry Student Information Form

AP Chemistry/Mr. Moskaluk: Student Information Form

This form is NOT an application. Please do not submit it until AFTER you have paid the course tuition.

Student First Name

Student Last Name

Student Nickname

Student Email Address

Please use the email address that you will be using for student/teacher communications.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Are you a homeschooler or non-homeschooler?

HS - Homeschooler: Full-time homeschooler or part-time homeschooler ("blended" learner). DS - Non-Homeschooler: Full-time student in a brick & mortar or online public, private, or international school.

Homeschoolers and part-time homeschoolers (blended learners) MUST pay the tuition to PA Homeschoolers to get a transcript!

Have you received your school's permission to add our AP Chemistry course to your high school transcript?

YES, my school has given their permission to add your AP Chemistry course to my high school transcript. N/A - I just plan to have the College Board send my score to colleges and WILL NOT need a transcript.

Age?

Grade level?

9th 10th 11th 12th

Gender?

M F

Birth Year?

What is the highest math course you have taken?

Students taking this course should be proficient in working with logarithms and scientific notation.

What is the highest chemistry course you have taken?

General Chemistry Honors Chemistry None

Do you have a Cengage account?

Yes No

When you start class, we'll send you the Cengage/WebAssign instructions and Course Key for Mr. Moskaluk's class.

Do you live in the USA or Other Country?

USA Other Country

Street

City

State

Zip Code

Country

Phone Number

How did you find out about our course?

We would appreciate it if you could let us know how you found Mr. Moskaluk's AP Chemistry course.

Is there anything else that you would like us to know about you?