AP Chemistry Registration

Mr. Moskaluk's AP Chemistry: Student Registration Form

We will use the information to create your student record.
Student Name*

Student First NameStudent Last Name
Student Email Address*
example@example.com
Parent/Guardian Name*

Parent First NameParent Last Name
Parent/Guardian Email Address*
example@example.com
Are you a homeschooler or non-homeschooler?*

Homeschooler or part-time homeschooler (blended learner)Non-Homeschooler in a public/private brick-and-mortar or online school
Will your school be adding our AP Chemistry course to your high school transcript?*

N/A - I don't need an official transcript for this course.Yes, my school has accepted your course and will add it to my school transcript.No, my school does not give credit for outside courses and I will need a transcript.
If your school does not give credit for outside courses AND you need an official transcript for this course, send a note to admin@chemadvantage.com.
Age next fall?*

1415161718Other
Grade level next fall?*

9th10th11th12thOther
Highest Math Course?*

Algebra IAlgebra IIPre-CalcAP Calculus ABAP Calculus BC
Highest Chemistry Course?*

General ChemistryHonors ChemistryNone
How did you find Mr. Moskaluk's course?*

College BoardPrep ScholarAP HomeschoolersFormer StudentHomeschool Parent/StudentClover Valley ChemistryBrick-and-Mortar School CounselorOnline School CounselorChemAdvantage
Do you live in the USA or Other Country?*

USAOther Country
Home Address*

Address Line 1

Address Line 2

CityState / Province / District

Postal / Zip CodeCountry
USA Phone Number
International Phone Number
Is there anything else you'd like us to know?
Please verify for us that you are human.*
Should be Empty:

Mr. Moskaluk's AP Chemistry: Student Registration Form