Name: __________________________

Log On ID: __________________________

E-mail Address: __________________________

Birth date: __________________________

Gender: __________________________

High School: __________________________

Counselor: __________________________

Science Grades: __________________________

Math Grade: __________________________

Biology Grades: __________________________

Why taking this course: __________________________

Goals for the future: __________________________

Year in School: __________________________

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I agree to abide by the Netiquette while enrolled in FHP.
Signature:______________________________