Supplemental Application

Student Name ____________________________________________ Grade____________

School Name____________________________________________________

Town_______________________________________________ State_________________

Dear School Administrator,

The student named above has expressed an interest in participating in the MOEMS®
(Mathematical Olympiads for Elementary & Middle Schools) program for the current school
year. In order for him/her to register with our team, we must first confirm that he/she does not
attend a school that already participates in Math Olympiads.

Please check the appropriate box below, print, sign and date.
This school DOES NOT have a MOEMS® team for the 2023-2024 school year.
This school DOES have a MOEMS® team for the 2023-2024 school year
(check all that apply)
Division E (grades 4-6)
Division M (Grades 6-8

Name/Title of Administrator (print) ______________________________________________

Signature: ________________________________________________ Date ____________

Thank you for supporting your student’s interest in mathematics and problem solving. If you
have any questions please contact me.

Sincerely,

______________________________________
PICO
Math Rangers
______________________________________
Name of Institute

________________________________________
mathrangersllc@gmail.com 7859798057
________________________________
Email Phone