Gifted Programs: You will receive information on opportunities for academically talented students. Would you also like to receive information from select private schools on their qualifying criteria and scholarship opportunites?

Yes NoCenter for Talent Development only endorses

programs it administers.

Parent/Guardian #2 First Name MI Parent/Guardian #2 Last Name

Phone (area code first) E-mail Address

Street Address

City State ZIP

Student First Name (First 18 letters) MI Student Last Name (First 18 letters) Gender M F

Special Accommodations: Each testing agency determines allowable accommodations and has its own application process.

(See Family Handbook 2015.) Required forms and instructions will be sent to you upon receipt of this completed form. Check here if requesting special accommodations.

Financial Aid: NUMATS fee is waived for one registration per school year to students who qualify (see Family Handbook 2015). An eligibility letter stating that the student qualifies, written on school letterhead and signed by a school official, is required and should be submitted to NUMATS with this form. We must receive the letter by the registration deadline to process registration for your chosen test date.

Registration is not complete until NUMATS receives this letter.Submit eligibility letter with this form. Students requesting financial aid and registering for ACT or SAT do not need to submit payment with this form; test-fee waivers are available on a first-come, first-served basis. Use Box 11-1, Line D and Box 11-2, Line J. (Students in grade 7 who qualify for financial aid will receive a JKC test fee waiver and should use Box 11-2, Line K.) Students requesting financial aid and registering for EXPLORE must include payment for the test fee only--$33 (+$14 late fee, if applicable). Use Box 11-1, Line D and Box 11-2, Line E or F.

School Information: Homeschooled OR Enter your school’s NUMATS ID number: ___ ___ ___ ___ ___ ___ ___ , if known, OR School Name: _________________________________________________________________________

School Address: ___________________________________ City, State, ZIP: _______________________

Qualifying Information I am a past participant in an Academic Talent Search. I qualify for the gifted program at my school. I have been recommended by a teacher or parent. I qualify on a nationally normed test. I qualify on a state achievement test. Parent/Guardian #1 First Name MI Parent/Guardian #1 Last Name

2015 Northwestern University’s Midwest Academic Talent Search (NUMATS)There’s a much easier way! Register online at www.ctd.northwestern.edu/numats/register.

Please print legibly, with only one letter or number in each box. Questions? Call 847/491-3782 ext. 3.

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1Current Grade Level 3 4 5 6 7 8 9*( )

MM / DD / YYYYDate of Birth

Ethnic Background (optional) African-American/Black Asian/Pacific Islander Caucasian/White Hispanic/Latino Native Alaskan/American Indian Multiracial Other ____________________ For statistical purposes only

Household Income(optional)

Under $20,000 $20,000-$49,999 $50,000-$79,999 $80,000-$119,999 $120,000 or above

Phone (area code first) E-mail Address (This e-mail address will be your username for your online Toolbox account.)

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Additional Score Reports: If you would like the testing agency to send your scores to up to two other institutions, enter the institution code(s): ____ ____ ____ ____ ____ ____ ____ ____

Participation Agreement (required)•I understand the requirements for participation in NUMATS and verify that my child meets all these requirements; I agree to the conditions of my child’s participation in NUMATS; and I give permission for my child to participate in NUMATS.•I will be charged $30 for each returned check.•I understand that fees are not refundable for any reason and may not be transferred to registration in future years.•I understand that if the test centers I requested are not available, the testing agency will assign me to the nearest available test center.•I understand that if I change the test date, I may be charged a fee by the testing agency.•I understand that my child’s scores will be available to the school or district if I provided the information in Box 3.•I understand that my child’s scores and contact information may be made available to other agencies or institutions to determine eligibility for award ceremonies, special programs, or scholarship opportunities.•Data Collection & Research: By participating in a CTD program, we understand that any data we supply with the application or that is generated as a result of participation in the program is collected in CTD’s databases, which are stored on a secure server maintained by Northwestern University staff only, and that aggregated and de-identified information may be used for program evaluation, quality assessment, strategic planning, and research purposes. CTD will maintain appropriate safeguards to protect the security, integrity, and privacy of students’ personal data.

Parent Signature _______________________________________________________________ Date _________________

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5

6

See Box 9

*SAT now requires all 9th graders to register for the test directly through their website: sat.collegeboard.org/register. After registering, request a score report to be sent to us by searching Colleges and Scholarships in Evanston, IL and choosing NORTHWESTERN UNIVERSITYS MIDWEST ACDMC TALENT SRCH to ensure you have access to all NUMATS benefits. On this form, use Box 11-1, Line C and Box 11-2, Line L.

EXPLORE: Offered to students in grades 3-6. Indicate a first- and second- choice test date and test center. For test center information, go to www.ctd.northwestern.edu/numats/program/test_center, contact the NUMATS coordinator at your school, or call NUMATS at 847/491-3782 ext. 3.

Credit Card Select one: MasterCard Visa Discover JCB Diner’s ClubCard number: Exp: / Billing ZIP Code: Signature: _________________________________________ Date:_____________ Amount: $________

Please enclose check or money order for the Grand Total amount made payable to Northwestern University or complete credit card information in Box 13. Mail registration and payment to arrive by the deadline for the earliest test you selected to

NUMATSCenter for Talent Development

617 Dartmouth PlaceEvanston, IL 60208

Indicate payment method: Check (enclosed) Money Order (enclosed) Credit/Debit card (Complete Box 13.)

Register for more than one test on the same form! Consider taking each test applicable to your current grade level. Testing before March is required for award ceremony consideration by some state organizations.

We must receive your registration and all accompanying paperwork by the registration deadline to process registration for your chosen test date.

Test Information Fees: Mark all that apply.

Test Date° Deadline Late Period (+$24 late fee) Test CentersSep 13 Aug 6 Aug 7-19

1st Choice:____ ____ ____ ____ ____ ____Oct 25 Sep 17 Sep 18-30

Dec 13 Nov 5 Nov 6-18Feb 7 Jan 7 Jan 8-13

2nd Choice: ____ ____ ____ ____ ____ ____Apr 18 Mar 11 Mar 12-24

Jun 13 May 6 May 7-19

Test Date Deadline Late Period (+$14 late fee)Nov 8 Oct 8 Oct 9-12Jan 24 Dec 17 Dec 18-28 Jan 25 **Non-Sat. See Box 10. Dec 17 Dec 18-28Feb 21 Jan 14 Jan 15-19

1st Choice: Date (circle one):Nov Jan Feb

Test Center:____ ____ ____ ____ ____ ____

2nd Choice: Date (circle one):Nov Jan Feb

Test Center:____ ____ ____ ____ ____ ____

7 NUMATS Fees:A. EXPLORE $38.00 = ____B. ACT $38.00 = ____C. SAT $38.00 = ____D. Financial Aid $0 = ____ (See Box 4.)

AND Test Fees: E. EXPLORE $33.00 = ____F. EXPLORE with late fee $47.00 = ____G. ACT $38.00 = ____H. ACT with late fee $62.00 = ____I. SAT $52.50 = ____J. ACT or SAT with Financial Aid $0 = ____K. JKC Fee Waiver (See Box 4.) $0 = ____L. SAT 9th grader $0 = ____

Total of 11-1 and 11-2 = $ _____

Optional:Imagine magazine is the only magazine written just for gifted students in grades 7-12. (See Family Handbook for more information.) Imagine subscription $30.00 = ____ (1 year - 5 issues)

Grand Total: $ __________

11-1

11-2

ACT: Offered to students in grades 6-9. Choose one test date, then enter first- and second-choice test centers. For test center information, go to www.ctd.northwestern.edu/numats/program/test_center, contact the NUMATS coordinator at your school, or call NUMATS at 847/491-3782 ext. 3.

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  SAT: Offered to students in grades 6-9. Choose one test date, then enter first- and second-choice test centers. For test center information, go to www.ctd.northwestern.edu/numats/program/test_center, contact the NUMATS coordinator at your school, or call NUMATS at 847/491-3782 ext. 3.

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Test Date Non-Sat Test Date** Deadline Test CentersOct 11 Oct 12 Sep 9 1st Choice:

____ ____ ____ ____ ____Nov 8 Nov 9 Oct 6Dec 6 Dec 7 Nov 3 2nd Choice:

____ ____ ____ ____ ____Jan 24 Jan 25 Jan 4Mar 14 Mar 15 Feb 10 *9th graders must also

register directly with SAT and have a photo ID.

May 2 May 3 Apr 1Jun 6 Jun 7 May 5

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13

For office use only CC MO Ck Ck/MO/CC $________ Ck/MO #__________ Pymt proc’d on ______ by ______ JKC Allowed ReleaseReg rec’d ________ by ______ School Pymt Bulk Paper Indiv Paper MATS FW Non-SatChecked on ______ by ______ SP Ck # ______________ SP approved/applied in WB on _______ by ______ Test FW Spec Acc Entered in WB on _______ by ______ E-mail conf sent on _______ by ______ Spec Acc sent on _______ by ______ No Sig NUMATS only

11 11

**Non-Saturday Testing: Students whose religious faith prohibits Saturday testing may choose a non-Saturday test date. Students must include a letter from their clergy requesting this option with this registration form. (See Family Handbook 2015 for more information.) Additional dates may be available in your state. Call us at 847/491-3782 ext. 3 for more information. Check here if you are choosing a non-Saturday test date for religious reasons, and indicate your preferred test date in Box 7, 8, or 9.

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** °ACT Non-Saturday test dates vary by state. Check ACT’s website for dates and test centers, and enter the test date here.___________________________________