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.

If you are a homeschooler whose schooling is overseen by a brick-and-mortar or online "umbrella" school, click on the "HS" button.

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

Great! On the first day of class, we'll send you the Cengage/WebAssign Course Key for Mr. Moskaluk's class.

On the first day of class, we'll send instructions for creating your free account along with Mr. Moskaluk's Cengage Course Key.

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?