STEM STEP Registration Form
Date
*
-
Month
-
Day
Year
Date
Student Name
*
First Name
Middle Name
Last Name
Student LACCD ID number
*
Student phone number
*
-
Area Code
Phone Number
Student LACCD email address
*
Student alternative personal email address
*
example@example.com
Math courses completed
*
Math 105
Math 112
Math 123 A
Math 123B
Math 123C
Math 234
Math 227
Math 240
Math 260
Statistics 1
Other
English Course Completed
*
English 21
English 73
English 28
English 31
English 101
English 102
English 203
English 215
Other
How did you hear about the STEM program?
*
Counselor
Workshop
Class presentation
Other
Which STEM major interest you?
*
Biology
Chemistry
Physics
Mathematics
Physiology
Comp. Science
Engineering
Other
When did you first enroll as a full-time student (12+ units) at LA Harbor College?
(Fall 2018, Fall 2019, etc.)
Submit
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