Math Power Boost Award Application Form

StuCdent information

First name *This question is required.

Last name *This question is required.

Email address *This question is required. This question requires a valid email address.

Cell Phone

Student birthdate *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Street address *This question is required. Do NOT use P.O. Box or you will be charged Non-Md Resident Fee

City *This question is required.

State *This question is required.

ZIP *This question is required.

Student M number *This question is required.

By typing my full name below, I understanded that the $200 award can only be used for WPS083 Math Power Boost and that the funds will only be posted to my account after successful completion of the course. I acknowledge that I have read the terms and conditions of the Math Power Boost Award listed above. I certify that this information is true and accurate. I agree to abide by the Policies and Procedures of Montgomery College. *This question is required.

Date: 12/10/2025