CCPA Request Form

California residents and consumers in Texas and Virginia may complete the following form to submit a privacy rights request under state law. 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?*

State of residence of the person to whom this request relates:

Your Contact Information:

First Name*

Last Name*

Email*

Phone*

Mailing Address*

What type of request are you making?*

If you would like to opt out of targeted/behavioral advertising through online technologies such as cookies, please click on the Do Not Sell or Share My Personal Information link in the footer of our website.

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. If you are a TX or VA consumer submitting an appeal, please explain why you believe our initial response to your request should be changed.

By submitting this form, I certify 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, depending on the nature of the request, 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.

Privacy Rights Request Form

Your Contact Information:

Information about the individual you are authorized to represent: