First Name        M.I.         Last Name

Please give us an up-to-date mailing address and contact information below.

Street Address

City         State          Zip

Email

Phone

OCtech Student ID number

Please answer yes or no to the following:

1. Have you completed English 101?	(pick one) Yes No
2. Have you completed Math 101?	(pick one) Yes No
3. Did you place higher than Math 101   on  the Math Placement Test?	(pick one) Yes No