Smarthinking Sign-up Form

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First Name/Primer Nombre*

Last Name/Appellido*

Phone Number (xxx-xxx-xxxx)*

Email Address

Please provide your H #/Proporcione por favor su # H*

Please check all that apply

Enrolled in Credit (Matriculado en clases de credito)

Enrolled Noncredit (Matriculado en cursos de no credito)

Are you working during the school year? (Yo trabajo durante el ano escolar) Yes

Yes

No

I worked____hrs/wk

5-10

11-15

16-20

over 20

I have interest in others academic and students support programs / Tengo interes de conocer mas de otros programas de apoyo estudiantil y academicos Writing Center (Centro de Escritura) Math Center (Centro de Matemticas) Tutoring Center (Centro de Tutora) Library (Biblioteca) Counseling (Consejeria)

Writing Center (Centro de Escritura)

Math Center (Centro de Matematicas)

Tutoring Center (Centro de Tutoria)

Library (Biblioteca)

Counseling (Consejeria)

Financial Aid (Ayuda financiera)

Form UUID Site Name Submit  Clear