Your First Name *
Your Last Name *
Your Email Address * Use school email address
State or Province * Please Select Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut D.C. Delaware Florida Micronesia Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Marshall Islands Michigan Minnesota Missouri Marianas Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Palau Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Military Americas Military Europe/ME/Canada Military Pacific Alberta Manitoba British Columbia New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
Country * -- Please Select -- United States Canada Puerto Rico Guam Mauritius American Samoa Other
School Name * Please type in school name after selecting state/province. Do not copy/paste.
Course *
Discipline * Please select... Accounting Anatomy & Physiology/Biology Architecture Business Chemistry Culinary Engineering Environmental Science Geography Information Systems Italian Math Nutrition Physics Psychology Spanish
WileyPLUS Platform * Please select... WileyPLUS WileyPLUS Learning Space WileyPLUS Next Gen
If you use an integrated version of WileyPLUS, please indicate your LMS * Please select... Blackboard Canvas D2L Moodle None
Please indicate whether this Student Partner is new to the role or has been one in the past * Please select... New Student Returning Student
Student First Name *
Student Last Name *
Student Email *
Name of Course Student Completed using WileyPLUS *
Courses student will be serving as Student Partner *
Will this student be a student in this upcoming term? * Please select... Yes No
