CCPA Request Form

California residents may complete the following form to submit a privacy rights request under the California Consumer Privacy Act (CCPA). Please see our Privacy Policy for more details.

The information you provide in this form will be used for the purpose of fulfilling your request. Depending on the type of request you submit, we may require additional information to verify your identity before your request can be completed.

Your Relationship with Mathnasium*

Are you submitting this request for yourself or on the behalf of someone else?*

Your Contact Information:

First Name*

Last Name*

Email*

Phone*

Mailing Address*

What type of request are you making?*

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Additional Information Please use the following box to provide any additional information relevant to your request. For example, if you are submitting a request to correct, please let us know what needs to be corrected and why it is incorrect.

By submitting this form, I certify that the person to whom this request relates is a California resident and that the information I have provided is complete, accurate, and up to date. I further certify that (a) I am the person who is the subject of the request or (b) I am authorized by the relevant person to submit this request on their behalf. I understand that it may be necessary for me to submit further information in order to verify this request and that my request will not be complete until all required information has been submitted.

Your Contact Information:

Information about the individual you are authorized to represent: