APPLICATION - CyberMath

REQUIRED FIELDS

Should take 2-3 minutes.

Parent's First Name*

Parent's Last Name*

Parent's Email Address*

Parent's Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student's Name*

First Last

Student's Email Address*

If student is under 13 and/or does not have an email address, please use a parent's email address.

Student's Phone Number*

Student's Gender*

This question is for rooming purposes.

Female
Male

Grade Level*

School*

Name of the school that student attends.

Desired Camp Location*

Harvard University

Choose Your Camp*

Final class placements will be decided based on the information you have provided in the school information and "Student's Academic Background" sections, as well as performance on the placement exam(s).

Advanced Middle School Math (Foundations)
Advanced Middle School Math (Mastery)
Advanced High School Math (Foundations)
Advanced High School Math (Mastery)

Attendance Type*

Day Student
Residential

OPTIONAL QUESTIONS

Not required but helps place our students in the best program for their needs and goals.

Student's Academic Background

Please list relevant course(s) that the student has taken, or is taking, with grades. Any after-school courses or camps attended can be added.

How did you hear about us?

Name of Agent

Please provide the name(s) of the agent(s) who referred you to CyberMath.

Website Name

Please tell us on what website you came across CyberMath.

CAPTCHA

Summer Camp Application

REQUIRED FIELDS

OPTIONAL QUESTIONS