LOOKSFAM PILOT RUN FORM

School / Institution Name *

Authorized Representative Name *

Representative Email *

Representative Mobile *

Program / Department *

Estimated No. of Students *

Where did you heard LOOKSFAM? *

Pilot Duration *

Pilot Run Objectives *

Improve board exam passing rate Integrate adaptive review tools for classes Supplement existing review programs Evaluate LOOKSFAM for long-term institutional use Others (please specify):

Terms & Conditions * I confirm that the institution is applying for the LOOKSFAM Pilot Run. I acknowledge that approval is subject to Bentamo - BNTM Technologies Inc. verification and availability. I understand that pilot access is for evaluation purposes only.

Data Privacy Consent: I consent to the collection and processing of information for evaluating eligibility and conducting the pilot run, in compliance with the Data Privacy Act of 2012 and GDPR (if applicable).