The H3O Group Inc. UWORLD Registration Form

REGISTRATION FORM
Registration Type
Student Information or Boot Camp Point of Contact
First and Last Name:
Student Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age:
Gender:
Email Address:
example@example.com
School(s) Desired To Attend
Required Acceptance ACT/SAT Score:
City:
State:
Educational Information
High School:
Current Grade:
Current GPA:
Projected High School Graduation Year:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Attending Title I School:
Have You Taken The ACT/SAT Before
If yes, which test:
Month
Year
Total Score:
How did you hear about the test prep program?

Other
Parent/Mentor Information
Name:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

REGISTRATION FORM