AP® Chemistry Application

Student Information:                                                                       

First Name
Last Name

Nickname (if any)

 Gender    Male  Female

Birth Date

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1988 1989 1990 1991 1992 1993 1994 1995

 Grade Level  (when starting AP Chemistry)   10th 11th 12th Other    If  "Other", please explain below:

 

Address Line 1
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City
State	AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Zip Code
Country	United States Canada Other   If other, please specify:
Phone Number
Email Address

 Are you a homeschooler?  Yes No

 Do you meet the prerequisite requirement of 1 year of high school chemistry?    Yes No

  If "Yes", which chemistry course?     Final Letter Grade?   Select A B C Lower

 Do you meet the prerequisite requirement of 1 year of algebra?  Yes No

 Please check any AP Courses you will have completed prior to taking AP Chemistry:

None	AP Art History	AP Biology	AP Calculus
AP Computer Science	AP Economics	AP English Language	AP English Literature
AP European History	AP French	AP Music Theory	AP Psychology
AP Statistics	AP US Government	AP US History	AP World History

 Please specify any AP courses not on the above list that you will have completed prior to AP Chemistry:

 Please check any AP Courses you plan to take along with AP Chemistry:

None	AP Art History	AP Biology	AP Calculus
AP Computer Science	AP Economics	AP English Language	AP English Literature
AP European History	AP French	AP Music Theory	AP Psychology
AP Statistics	AP US Government	AP US History	AP World History

  Please specify any AP courses not on the above list that you plan to take simultaneously with AP Chemistry:

 

 How did you hear about our AP Course?   [referred by?] PA Homeschoolers College Board List of Approved Courses ChemAdvantage Student (prior or current) Google, Yahoo or other search engine Other

 If other, please explain:

 Supervising Parent/Guardian Information:

Supervising Parent/Guardian Name
Supervising Parent/Guardian Email