Achieving College Success Registration Form
Summer 2023 Achieving College Success Math Registration Form
Sign in to Google to save your progress. Learn more
1. Last Name *
2. First Name *
3. Day time phone number *
4. Evening phone number *
5. Active Email address *
6. Home mailing Street Address *
7. City *
8. State *
9. Zip Code *
10. Have you attended the University of Akron? *
11. If you answered yes to question 10, enter your UANet ID if known, otherwise enter NA. *
12. If you answered yes to question 10, enter your UA ID number, otherwise enter NA. *
13. Enter your birthdate MM/DD/YYYY. *
MM
/
DD
/
YYYY
14. How did you hear about the program? *
15. Do you have internet access in your home? *
16. Do you have a computer or tablet with access to the internet(not a cell phone)? *
17. What is your career goal/major? *
18. Have you ever served in the US Armed Forces? *
19. Choose one or more races you consider yourself to be: *
Required
20. What is the highest grade or level of school compelted? *
21. What is your current employment status? *
22. Please list emergency contact information(name, relationship and phone number) that can be reached during class time. *
23. Please write any additonal information you would like us to know in the space below.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms