Thank you for your interest in the Worldview Checkup for Schools.
Please provide the following information so that we can send you
the appropriate assessment tool.  If you have more than one
class you would like to test, please fill out one form for each
group.  You will receive a unique assessment link for each class.


School Name:




First Name:




Last Name:





Teacher
Administrator
Other


Phone (XXX-XXX-XXXX format):


What is your e-mail address?




Please re-enter your e-mail address for confirmation.
(Must be identical to your entry above.)




Street Address:




City:




State or Province:


Zip:


Class Teacher's Last Name:




Class Name/Section (e.g., Junior Bible Class, 2nd Period):

(If signing up multiple classes, this must be unique for each class.)





Freshmen
Sophmore
Junior
Senior


Class Enrollment:

Students in Class: