September 19th ACT Prep Registration Form

Registration Form for the September 19th ACT Test Prep Course

Fill out the form carefully for registration
Parent Information
Parent Name

First NameLast Name
Parent Phone

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Parent Email
Email
Address

Street Address

Street Address Line 2

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Student Information
Student Name

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Student Phone

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Student E-mail
example@example.com
School
Grade Level
Current Composite Score
Goal Score
Class Information
Location
Course Type
Course Day/Time
Is the student taking the science test?
The science test is now optional and NOT included in the composite ACT score.
Diagnostic Test Date
Earliest possible is best
Final Mock Test Date
Latest possible is best
Modified Class Schedule - For MAKE-UP DAYS or CREATING YOUR OWN SCHEDULE:
If you are signing up for a course and have a class date that will be missed, please let us know which day, and we'll schedule a make-up class once classes start or you can list a possible make-up day, and we'll let you know the availability once classes start. If you are using the Create Your Own Schedule Option, please list out the days and times that you would like. We will check availability and get back with you. Make-up days and Create Your Own Schedule days are not guaranteed but can usually be accommodated. ACT Course Hours: M/W 7-8:30pm, T/Th 4-8:30pm, Sun 1:30-5:30pm. One-on-One Tutoring Hours: contact us.
Emergency Contact

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Additional Comments

Class Payment

STANDARD Course - September 19th ACT

3-Point Score Increase Guarantee - 15 Hours of Tutoring - Diagnostic and Mock Tests

$899.00

CRASH Course - September 19th ACT

7.5 Hours of Tutoring - Diagnostic and Mock Tests

$449.00

One-on-One ACT Tutoring - Hourly Rate

Use this option if you prefer one-on-one tutoring instead of a course OR if you would like to add on extra hours.

$149.00 Quantity

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Registration Form for the September 19th ACT Test Prep Course

Parent Information

Student Information

Class Information

Class Payment*

Payment Methods

Class Payment