Home - NetMath High School Registration Form

Name:

Gender:

Male Female Prefer Not to Answer

Birthdate:

Address:

Phone Number:

Email Address:

(A confirmation email will be sent to this address after you submit your application. Please use an email you check often.)

NetMath Course:

Select the course you want to enroll in, from the list. Learn more about the Courses offered.
Note: Only select the PHS section if you are affiliated with that program. Otherwise, your request will be automatically voided.

Number of Credit Hours:

(Note: Credit hours will auto load based on the course selected from the NetMath Course list above)

Desired Course Registration Date:

(Note that it may take up to 2 weeks from the registration date to start the course)

High School Name:

Principal Name:

Principal Email:

(A confirmation email will be sent to this address after you submit your application.
So, make sure you provide the correct email address)

Current GPA:

Point Scale:

School Address:

Year in School:

Freshman Sophomore Junior Senior

Are You Home Schooled:

Yes No

School District's Name/Number:

Contact someone at your school who will act as your High School Coordinator. Usually a counselor or teacher will act as a coordinator.

Coordinator Name:

Email Address:

Check this box to copy High School address here (if Coordinator's official address is same as your High School Address)

Coordinator Address:

(If different from high school address above)

COVID Update: Due to pandemic-related school closures, high school students may take online exams in all NetMath courses. Students are not required to submit proctor information on the HS Registration Form at this time. Please skip this section of the form.

Note: To be a proctor, the individual must meet at least one of the following criteria, and not be a member of the student’s family: Principal or Superintendent of Educational Service Region, School, or District, either Public or Parochial; Dean, Academic Department Head, Extension or Correspondence Administrator, Registrar, or Official Testing Service of an Accredited University or College; Full-Time High School or College Instructor or Librarian; Educational Officer (Armed Services Personnel Only). Exams will only be mailed to institutional addresses. Read more about proctors.

Proctor Name:

Email Address:

Proctor's Institution Address:

(If different from high school address above)

A confirmation email will be sent to the parent to confirm their consent.

Parent Name:

Email Address:

(A confirmation email will be sent to this address after you submit your application. So, make sure you provide the correct email address)

Have you previously registered with University of Illinois:

Yes No

Term of Enrollment:

(If Yes, list your last term of enrollment (month/year))

First, identify whether or not your ethnicity is Hispanic or Latino, regardless of race. Second, select one or more races from the five racial groups. Your response to these items is voluntary. Please enter your ethnic and racial identification information to help the University meet its federal reporting obligations. Additional information about these regulations is available on the University of Illinois web site at http://www.vpaa.uillinois.edu/RaceEthnicity

Are You Hispanic or Latino:

Yes No

Indicate the race(s) with which you identify:

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Tribal Affiliation:

(If you chose American Indian or Alaska Native as your race, please list your tribal affiliation)

NetMath High School Registration Form

PERSONAL INFORMATION

CONTACT INFORMATION

COURSE INFORMATION

HIGH SCHOOL INFORMATION

COORDINATOR INFORMATION

TEST PROCTOR INFORMATION

PARENT INFORMATION

ACADEMIC HISTORY

CITIZENSHIP INFORMATION

ETHNICITY INFORMATION